Sex in Menopause: Grin? Or Just Bear It?

Eight women sitting around my living room talking about sex -- all of us on the downside of 50 -- and even my ears burned from the sizzle of passion and rawness of confession. The idea that a contemporary women's sex drive disappears in middle or advanced age is as obsolete as the notion that women go batty in menopause. But many of us are ignorant about what changes to expect in our sexual responses during this passage, and the unforeseen consequences can drive us a little crazy!

Craemer, a lusty-looking California woman, told us she started menopause early, at 44. When night sweats made her feel as sexy as melted candle wax, she began mainlining tofu and soy. Her flashes subsided. She still enjoyed sex and continued to have lots of it; she was a single woman.

"At 48, I was with a younger man who was very well-endowed," she said. "It was wonderful at the beginning, then it started being less comfortable, and after awhile it was like, 'Oh, my God, major pain!'" Craemer had a bias against hormone replacement -- taking the risk of breast cancer just to remain a sex object wasn't a good tradeoff, she believed -- and she felt like she was still lubricating very well when aroused.

"I kept promising I'd find another gynecologist, but I didn't. And finally, when sex literally became a pain, we split up."As more and more women go off hormones cold turkey or enter the tumultuous phase of perimenopause confused by all the conflicting advice, there is a danger of reviving the myth that sex after menopause is merely a chore.

It's not. In fact, in interviewing hundreds of women between 45 and 75 for my book, Sex and the Seasoned Woman, it is plain that many are finding far greater pleasure and contentment in "middle-sex" than they did in their younger years or their first marriages. Just about everybody has a preconceived idea of what menopause will be like and when it begins. Women accustomed to catastrophic thinking may worry it will hit them as early as their mid-30s (very rare). Women who are menophobic may refuse to acknowledge they are in menopause. And some of us are just plain ignorant. I was 48 and recently remarried, quietly reading on a snowy Sunday night and playing footsie with my new husband, when a little explosion went off in my brain. It felt like a power surge. I looked down at the pages I had just finished reading and my mind was blank. I felt hot, then clammy and cold. I lay down, but my heart began racing. For the first time since my earliest period, I felt profoundly ill-at-ease within my body. As more mysterious changes followed over the next few months -- sudden energy crashes, bouts of the blues, bloating, headaches, heart palpitations, mind fogs and, of course, hot flushes -- I began to wonder if I was losing it. Not only losing my mind, but losing my usual sexual lan. I felt about as desirous and desirable as a day-old bread that's been reheated in the microwave.
The worst part was the fear that this metamorphosis was going to change me into an old woman overnight, and I would never be the same me again. Well, I was right about the last part. I'm not the same "me" as I was in my First Adulthood. But I feel like anything but an old woman, despite the fact that I now have 15 more years of tread on my wheels. All those mysterious maladies subsided as I went over the hump of what singer Joni Mitchell calls the "middle-life crazies." I came out the other side feeling stronger and surer than ever -- and sexier, too. Why? Because I'm less inhibited. Older is bolder. Pre-emptive Protection Leslie Ann, a petite 55-year-old massage therapist with two marriages behind her, identified with the problem of physical changes that Craemer had described. "My younger Latin lover came back into my life after a long, dry period without sex. I was so tight! But I pretended I was a virgin again." Hilarity broke out. It was fun to hear a woman put a grin on the common dread of bearing up under painful, postmenopausal sex. But it's not a laughing matter when making love becomes so painful that the partners can't pretend anymore, and ultimately split up. Leslie Ann admitted that her "re-virgination" didn't stop her younger lover from finding someone else and leaving her.
The truth is, almost all women after menopause will have changes in the vagina from loss of estrogen. The lining of the vagina -- pink, plump and juicy tissue when it is estrogenized -- grows thinner. Once this tissue is maybe only one cell thick, it often tears when the penis enters. A woman may not be aware of these microscopic tears. "There's this sandpaper-like feeling when he enters me," say women often describing the sensation. Or they feel stinging upon entry of the penis. Or after they have sex, thinking they were lubricated because there is still a watery moistness, they feel stinging when they urinate. That means there has been a tear. Those microscopic tears build up and then easily invite bacteria and infection. It's a vicious cycle. Also, the vaginal tissue stops lubricating the way it did before menopause. Dr. Monica Peacocke, a scientist and vaginal specialist in New York, describes the difference between "good lubrication" and "bad lubrication." The good kind is the thick and gliding mucus that flows during sexual arousal in women who still have normal estrogen levels or are using hormone replacement. The "bad lubrication" is thin and watery due to the decreased estrogen after menopause, and while it may feel like normal moistness, it does not smooth the channel for the penis.
A whole cottage industry of specialists has sprung up to help rehabilitate this most intimate part of the female anatomy. The good news is, this vicious cycle can be avoided if a woman knows what to expect. "Pre-emptive action is called for if a woman plans to go on having sex," says Dr. Patricia Allen, a wise and witty New York gynecologist who often counsels menopausal women about sexual health, "because once we get to the Sahara desert of the vagina, it can take months to get the vaginal tissue back to pink, healthy and uninfected, and to re-establish the right PH balance. And," she smiles, "make the desert bloom again." The old-fashioned remedy is a vaginal cream, like Premarin cream or Estrace, which contains estradiol. When Craemer did finally get herself to a new gynecologist, (albeit after the barn door had closed on her romance with Mr. Well-Endowed), she agreed to try Estrace. "That made all the difference in the world," she said. "I wouldn't say my sex drive is what it was before, but I feel it has a more appropriate place in my life at this stage. Instead of feeling desperate to be touched and have sex, now it's just a wonderful outcome of intimacy."
The real secret is that the biggest sex organ is between the ears. Craemer was in denial that she had reached the stage of menopause. Once she let go of the desperate need to prove her perpetual youthfulness and made the passage, she found herself able to enjoy a sexual partner who was more than 10 years older. "He takes care of me before he takes care of himself," she confides. "I don't have to see him every night. It's better, because now I have time for my work and to go dancing!" Many women, however, complain that the local estrogen creams are messy, and they worry that too much of the hormone may be absorbed into the general bloodstream. Dr.Allen favors the increasingly popular pre-emptive medication Vagifem. It is a tiny estrogen tablet that is inserted into the vagina. It is easily absorbed, locally, but not absorbed into the general bloodstream, so it does not carry the risks that overall hormone therapy present. One of Dr. Allen's patients insisted upon a prescription for the cream version before she took a vacation trip to the Grand Canyon. After a week, the woman called from her mobile phone while riding a packhorse. She sounded frantic: "My labia looks like a baboon's ass."
"What have you been doing?" the doctor asked. "It must be this cream you gave me." The doctor reviewed her notes. The patient had insisted upon using the cream when her insurance company refused to cover Vagifem. "You must be allergic to the cream," the doctor told her. "Stop using it. Try a cold compress, a little antihistamine, and get off those pack horses!" After two hours of conversation in my living room, Bernice, a svelte, silver-haired dynamo who still works full-time as a retail manager, felt comfortable enough to tell us her age -- 75. But the more startling confession, she said, was the one her 93-year-old mother made as she reminisced about her half century of married life. "We didn't have enough sex." No matter how old we are, we never lose the hunger for a loving touch and emotional closeness. Among women of a certain age, those aspects of a relationship are often more important than the sex or, at least, the starting point for satisfying sex. Jack Nicholson, as Melvin the homophobic curmudgeon in the movie, "As Good As It Gets," bursts into a hotel room and finds his lady love, the waitress Carol, played by Helen Hunt, in bed with their gay traveling companion. "Did you sex with her?" Melvin demands.
Carol responds, "To hell with sex." She looks hard at Melvin, who ducks her gaze. She then smiles at her gay friend: "We held each other. It was better than sex. What I need, he gave me great." We never lose the need for touching. We are animals, after all, and when did you ever meet a dog or cat who didn't need petting? If touching is not available by a romantic partner, then seek out a massage therapist. It's worth the money. Pets are great touchy-feely companions, and the best ones feel your pain. When you're home alone on a Saturday night, don't drown your hot flashes in drink (which only makes them worse). Just curl up with a good vibrator. When I attended a conference on the older woman at Esalen, I was fascinated to hear women in their 70s acknowledge their need for some form of physical intimacy. And not exclusively with a male. It might be hugging with women friends, smooching with grandchildren or lavishing attention on pets. They found it essential to have someone to touch, to hold, to share affection with. Some spoke enthusiastically about having active and satisfying sex lives. One lean, sportive woman of nearly 80 years had not spoken up. I asked pointedly: How do you feel about the automatic assumption that women over 70 lose all interest in sex. She paused and allowed a sly smile. "This is how it is for me. I've become a vegetarian, but every once in a while I want red meat. I go out and get it and eat it and enjoy it." Gail Sheehy is a journalist and author of 15 books, including Passages, New Passages, The Silent Passage, and Sex and the Seasoned Woman. Visit www.gailsheehy.com.
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