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Home » Testosterone » How to have great sex at any life stage (and that includes menopause) – Telegraph.co.uk

When was the last time you chatted to friends about vaginal dryness? Or talked about your favourite lubricants? How about, um never? We might be happy to swap hot-flush horror stories over a glass of picpoul, but when it comes to the effect of the menopause on our vaginas well, thats quite a different matter. And even if we do confide in a friend, we may be too shy to talk to a doctor. Take Louise, 53, who had a great sex life with her five-years-younger husband until the menopause started. Sex became painful, so my sex drive just faded away, she says. Have I seen someone about it? No. Its embarrassing. And what could they do, anyway?

Louises fatalistic attitude is one that Dr Philippa Kaye is on a mission to change. Dr Kaye, a fabulously straight-talking 40-year-old GP, is the author of The M Word: Everything You Need to Know About the Menopause, and she is determined to get us all talking about menopausal sex.

The problem, she says, is theres a taboo around female pleasure and around talking about sex as we get older. The words vagina and vulva should, she insists, be about as embarrassing as elbow and knee. If we get more comfortable talking frankly about sex, perhaps well be more comfortable asking for help.

Dr Kaye points out that sex remains important in midlife and beyond. In 2016, data from the English Longitudinal Study of Ageing showed that over half (54 per cent) of men surveyed and about a third (31 per cent) of women are sexually active over 70. A 2005 US study found that almost half of couples aged 60 to 69 had sex at least once a week, with over a third of couples over 70 saying the same. Sex matters. For many, its vital to a relationship, not simply for physical gratification but for intimacy and closeness, she says.

This is why shes often the one to raise the issue of sex in her consultations. Women are frequently surprised to learn their symptoms could be related to menopause, and grateful when I tell them nobody has to put up with painful sex or a low sex drive.

By the time we hit menopause, our bodies produce half as much testosterone as when we were 20. The result can be a flatlined libido. As well as boosting sex drive, testosterone can give women back their oomph, says Dr Kaye. I often see patients who use a smidge of testosterone gel in addition to their regular HRT, and they are all: Hello! Here I am!

Women only need a pea-sized dose of gel, rubbed into the lower abdomen or thighs daily. It can take up to six months to notice an effect, but Kate, 56, says, Im three days in and dont know why I didnt do this years ago. Im even looking at getting back into dating.

Loss of desire can also be a side-effect of depression or anxiety, and HRT can often help. Dr Kaye says, If you experience your first episode of depression or anxiety aroundperimenopause, then HRT should be the go-to treatment, not antidepressants. It can also help you sleep better, improving energy.

An alternative to testosterone and HRT is Tibolone, a synthetic steroid that has the properties of oestrogen, progesterone and testosterone. It can have more side-effects than HRT, and has a similar risk profile. However, if you are looking for an all-in-one preparation, it might be the answer.

If sex doesnt feel as good and orgasms are elusive, vibrators can help. Research shows vibrators dont just improve sexual response, they are also associated with better sleep, and reduced pain and stress, says Dr Kaye.

Vaginal dryness affects up to four out of five women after the menopause, and at least half suffer from genitourinary syndrome of menopause (GSM). Symptoms of GSM, which can develop years after your hot flushes have disappeared, include loss of tone in the vagina, fragile, thinner tissues, itching and burning, incontinence and dryness. This is where topical vaginal oestrogen comes in, explains Dr Kaye. Its applied in the form of a cream or pessary up to five days a week, or as a vaginal ring, which disperses oestrogen slowly over three months. The great thing about vaginal oestrogen is that although technically its a form of HRT, very little gets into your system, she says. Using it for a year is equivalent to taking just two HRT tablets.

Vaginal oestrogen can reduce the risk of UTIs and, says Dr Kaye, can also normalise the vaginas pH and microbiome, the healthy bacteria that live in the vagina. We now know the vaginal microbiome is very important and may even play a role in preventing cancer. You can use topical oestrogen alone if dryness is your only symptom, or with HRT.

Alternatively, Ospemifene is a non-hormonal drug that has an oestrogen-like effect in the vagina. One advantage, Dr Kaye explains, is that you can take it even if you are undergoing breast-cancer treatment.

Laser treatments, which involve using a laser wand inside the vagina, are claimed to stimulate healing and improve the quality and elasticity of vaginal tissues. A recent study showed results similar to those of topical oestrogen. However, says Dr Kaye, the treatment is expensive and, in the wrong hands, potentially risky. Only consider having treatment with a gynaecologist, never on the high street, she advises.

You moisturise your face every day, but how often do you moisturise your vagina? When it comes to the itching caused by GSM, it can work wonders, says Dr Kaye. She recommends either Yes vaginal moisturiser (yesyesyes.org) or Regelle (regelle.co.uk). If you are dry and itchy, start off by using them daily, and then, after a week or two, you can decrease to every three days.

Painful sex due to GSM can, says Dr Kaye, easily affect libido and your psychological response to sex. If sex is painful once, you are likely to worry about the next time, so you feel more tense and it becomes a vicious circle. While HRT and topical oestrogens help with dryness long-term, a quick fix to make sex better is life-changing double-lubing.

For slipperier, sexier sex, she advises using two lubricants, one oil-based, one water-based. Oil and water dont mix, so an oil lubricant will slide over a water-based one. You can put the water-based lubricant on you internally, and then the oil-based on him. Try it! (Find them at yesyesyes.org.)

But remember, warns Dr Kaye, oil-based lubricants damage condoms, so dont use them if you are unsure of your partners STI status or are still using contraception.

Bearing all that in mind: go, get the best sex of your life. Happy Valentines.

The M Word: Everything You Need To Know About the Menopause by Dr Philippa Kaye is out on Thursday (9.99, Summersdale)

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How to have great sex at any life stage (and that includes menopause) - Telegraph.co.uk

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Home » Testosterone » How to have great sex at any life stage (and that includes menopause) – Telegraph.co.uk