I was talking to a psychiatrist friend recently about the pressures that life in the 21st century can impose upon us.  She pointed out “we are supposed to be slender, attractive, smart, successful, great parents, supportive children, concerned friends, physically active, eat 5 a day and on top of that be sexually active”.  This really made me stop and think.  I do not want to be thought of as someone who judges others as in any way ‘lacking’ if they are not sexually active, nor one that imposes any pressure in that way.  If people do not want sex, I’m cool with that!  Be who you are, stand tall and screw social media, that’s what I say!

But for those wondering how to find a solution to any of a massive range of sexual challenges, how do you start?  Do you go to the library (if you can find one still open), do you spend hours on the internet Googling sex and menopause, loss of libido or painful sex (other search engines are available, as are other complaints) or do you talk to someone?  If you talk to someone, who will that be?  Your best friend or a stranger on the bus?  Your GP?  A gynaecologist?  A sex therapist?  Do you join a facebook forum or do twitter, instagram or some other platform and gather general opinion?

The thing is that there is a general sense that women are better at talking about real life sexual problems than men are, but there is also a bucketful of evidence to show that women are very reluctant to talk to a health professional about even the most troubling of menopausal symptoms; frequent hot flushes, brain fog, night sweats, mood swings, loss of libido, anxiety and depression, painful penetration, leaky bladder…but why? 

There is personal embarrassment associated with sex-talk for sure but its more than that.  It seems that there is a kind of fear of being judged, like the message ‘women have been doing menopause since the dawn of time” should mean that we ought not to benefit from medical advances, and a worry that a GP will dismiss the problem as a waste of their time, like ‘we are not worthy’. Not wanting to embarrass the doctor with your sex related concerns is a classic; not feeling entitled to trouble the doctor because they are busy people and their time is precious is another, (and this is common) waiting until there is a ‘real’ other health problem and building up courage to add sex on the end of the consultation. ON THE END????  NO, NO, NO.  Please no.  You are entitled to a comfortable body and sexual freedom and to health care. Its ok to ask, really, ask…but I know that there is the added issue that if you are feeling low and anxious, all of the previous ‘fantasy negative outcomes’ are magnified in your mind x 10.

Oh, how I want to empower all women.  Please listen.  Because if you were born with a vagina, you are pretty likely to experience some menopausal changes. Talk and seek help when it is needed. Our generation has the biggest opportunity of all women that have gone before to get help and to educate our children, to show them that the menopause does not have to be just ‘endured’, to prepare them and to demonstrate an attitude of ‘I’m worth it, I deserve it, I have a voice and I will be heard’.  Help yourself… and help our kids.

My mum died when I was 33.  She had ‘warned’ me about periods, aged 10, and that was the end of any reference to anything that might happen between my nipples and my knees.  We did not discuss sex, pleasure, pregnancy (or protection). That’s the kind of family we were, no blame, its was just taboo. (I became a sex therapist after her demise…God knows what she’d have thought!!). I left home at 18 and I have no idea about her experience of the menopause.  My dad was killed in an accident, so I can’t ask him, and I have so many questions as I experience my own ‘change’.  I wish I knew.  And this is not a conversation to be had only with daughters by the way!  Our boys need to understand too. Their attitude could be very useful to another woman one day.

But really, the first conversation is to be had with your partner if you have one –  recruit them as an ally in the quest for support.  Your sexual interest will likely benefit them after all!  Explain what’s going on for you, how you feel and how you appreciate that this is affecting them too. Be curious and try to approach this in a solution seeking manner, an adventure even! (Now I know that this sounds like I am focussing on intercourse when I talk about partners, but really, I am talking about all of sexuality in its widest context…you being comfortable and confident in your skin = incredibly sexy!)

I talk to a lot of people about sex.  It is common that couples do not speak of ‘it’.  They have sex in the time-honoured fashion, have a routine that serves them well and it is only when there is a significant change to one or the other partner that there’s a hiccup.   Some hiccups are managed.  Some are not and for many couples, there has been no practice at talking about sex, because neither has felt that there needed to be.  Things were ok.

Some relationships trickle into sexless futures during the menopause. Some however, grow and blossom and coupes fall in love (and lust) all over again….but not usually just by magic.  They manage that through connectedness, compassion, communication and curiosity.

When people come to sex therapy, we therapists are super keen to look at the sexual challenge from all angles.  The biology, the psychology and the sociology, from both partner’s perspectives and this is a great template that you can look at for yourselves. It is called the biopsychosocial model.

Its so easy to think that you understand each other, know everything about each other, to think that you are almost one person, and it is sometimes a revelation to appreciate that you are different individuals, with different history, living different realities.  How do those experiences affect your sex life as your body changes?  This applies to all sexual and gender identities – we all react, cope and adapt differently.

Where to start?

How about you consider just the biology of the situation firstly? Can you put into words –

What is going on hormonally?  What changes are you feeling in your body? Where?  What is your age or stage of life?  Do you have other illnesses, injuries or treatments that are affecting how you see yourself as a sexual being? What about medication or medication side effects?  Sexual function?  Fertility/Contraception?  Libido?  Pain?  Continence? What about lube – is what you are using good enough?  Of these changes which ones could you do something about if you chose to? Who might be helpful to you?

Next it is good to think about the psychology. 

What are your attitudes and beliefs about sex? What are your attitudes and beliefs about the menopause?  What are your fears?  How are you emotionally, what are your coping strategies and are they healthy/useful to you?   Do you have additional stress in your life right now? Has there been any past trauma that may be affecting you now?  What are your hopes for the future, generally and sexually, and are these shared?  How do you feel about this?

And then there is the social situation. 

How do you feel about your partner relationship?  What social support or social burdens do you have? What about your culture or religion or traditions about sex or health?  Are you financially ok, what about work, do you have hobbies, do you have other friendships? Are these useful to you?

And then, when you have really considered all of this for yourself, consider that your partner may have a very different answers to yours.  Talk together, compassionately. Do they have their own problems, stresses, health challenges etc?  It can be so good to really understand and to know that you have been heard – to work with and grow that connectedness, compassion, communication and curiosity previously mentioned – and to seek solutions as a unit.  

And if that includes a trip to see your GP, you have my permission to embarrass the hell out of them if that’s what it takes to get the biology sorted out. You are a strong, beautiful woman and you are worth it.

If you need help from a psychosexual therapist with any of the rest, you know where I am!

This is the webinar link if you are interested to watch –