October is World Menopause Month and Dr. Erika Clay is talking to us all about sex after menopause, vaginal dryness, desire, and so much more!
Joining me today is Dr. Erica Clay. She is a certified OB GYN and is a leader in women’s health care, providing comprehensive care for women throughout their lifespan. She developed her own sexual health class along with teaching other related classes on various topics in women’s health to her patients, staff, and colleagues. In 2019, she completed the sexual health certification program and earned a certificate in sexuality education and counseling.
What is the definition of perimenopause and menopause?
Menopause is when a person has gone one full year without having a period. Perimenopause is when you start to notice that your periods are changing, when you start to have symptoms of menopause but you’re still having periods. The most common perimenopause symptoms women experience are hot flashes and night sweats.
How is sex affected by menopause?
Hormones affect every aspect of our body and especially our reproductive system. People who have vaginas and vulvas will often experience decreased natural lubrication and increased sensitivity in the skin. Those two things alone can lead to more uncomfortable or painful sex.
How do you help a woman who is suffering from painful sex or dealing with these changes as they age?
First of all, we want to make sure the painful sex is from menopause because there can be other causes even within the menopausal age range. Once confirmed, there are a few things that I typically recommend. I always recommend lubricants. People from the beginning of their sexual debut should be using lubricants, but especially when we see skin changes in menopause, lubricants are going to be very helpful in reducing the friction and discomfort, making sex a lot more comfortable. I also recommend vaginal moisturizers. Similarly to putting moisturizer on your face, they are designed to help retain moisture in the skin. this will make sex more comfortable on a more long term basis. And depending on the person, hormones in the vagina is a helpful option for improving painful sex related to menopause.
Can you recommend a vaginal moisturizer?
There are two that I recommend. One is called hyalogen. This vaginal moisturizer has hyaluronic acid. Hyaluronic acid is very beneficial for skin on your face and as well as skin in the vagina. It’s not in stores yet, but you can get it online. Revaree is another one that I have had good success with. There are a lot of options on the market. You just want to make sure that when you’re using moisturizers, just like the ones for your face, that you use it consistently as you would a daily facial moisturizer.
Is it true that if you don’t “use it” you will “lose it?”
It is 100% the truth when it comes to the vagina. The vagina, just like any other muscle in the body, is surrounded by muscle tissue. The less you use those muscles, the less fun you’re gonna have with them. If you don’t create friction, or use the vaginal muscles, those muscles become atrophy, meaning they get smaller, less flexible, and less willing to be used, especially with menopause. Therefore, you can get painful sex just from not having sex regularly. Sex is what the doctor ordered. It’s a great way of maintaining blood flow to the vagina, which helps with the skin changes, keeping the muscles nice and healthy and tone, which can also help reduce pain. It doesn’t mean you have to use them every day or multiple times a day, just regularly. What you want to do is use those muscles and achieve an orgasm. If you can get blood flow to that area, that’ll help. That could mean partnered sex, so solo sex. Both can give you the same beneficial effect.
What can women do if they are experiencing low desire?
First of all, low sex drive is incredibly common, and especially in women. Secondly, there is no “normal” sex drive; we are all different. The only normal is what’s normal for you. But if you feel like you’re suffering from low sex drive, or if you’re not sure, the first thing you can do is talk to your OB GYN. All OB GYNs are trained in sexual dysfunction or treatment of sexual issues to a degree. If that OB GYN is not able to treat you, they can refer you to someone like me. So, first thing is to have a conversation with your OB GYN.
Are there different types of sexual desire?
There are essentially two types of sexual desire. One is responsive desire, which is what most people think women have. It is a growing interest in sex that occurs in response to sexual stimuli. Whereas spontaneous desire is what a lot of people feel men have. This is an interest in sex that seems to come out of thin air. Now, people can have both types of desire, depending on the situation.
How do you discover where you fall between responsive and spontaneous desire and how to work with your type of desire?
A lot of it has to do with introspection and reflection. Most people are going to have a combination of both responsive and spontaneous desires, and will have a dominant type of desire that they tend to gravitate towards. So, really it’s about just thinking about your sexual experiences. Try thinking about your last sexual experience, and how that began. Was it a situation where you were watching a movie with your partner, and it was a comedy, and you looked over and thought, wow, I am really attracted to you right now, and I want to have sex with you? Or was it a situation where you went out for a romantic dinner, you had a couple of glasses of wine and then after that, you started noticing a sexual desire? You would be more responsive if you’re the kind of person who needs the stage set or you need to have effort put in beforehand. You would be spontaneous if you were doing something that’s not sexually related and sex comes up for you. Or you could be both. So, think about your sexual experiences and where you fall in the spectrum. Once you’ve determined that, then take those experiences and highlight them, capitalize on them. So if you’re someone who gravitates more towards responsive desire, then if you have a partner, let them know, hey, I need a little bit more for play, a little bit more effort put into the intimate experience can be very helpful at improving low sex drive, improving intimacy, improving relationship bonds, versus someone who just randomly has a spontaneous desire. It’s just capitalizing on those events when they happen.
Most women are more responsive, in that they need the scene to be set, so how could a person who really is holding back try to cultivate their responsive side?
Emily McCarthy’s book is a good place to start, especially for women who have low desire. But most people have a lot of great insight about things that are hard for them, whether it’s having young kids, having grown children living with them, not having privacy, working too much, etc. Whatever it is, try and figure out what is inhibiting you, and then try and work around it. Having young children tends to be a big problem when it comes to desire, so in those situations, you can try weekends away, date nights, having family members watch your children, so you have uninterrupted time. Even if that time doesn’t necessarily end up with sex, that intimate time, that quality time together can have a huge impact on your sex life overall.
If you are a single person with children, make sure that you have the time to create pleasure for yourself, whether it’s just enough time to take a bath and masturbate or take yourself out to dinner, whatever it is.
If you’re in a partner situation, particularly if you are in a heterosexual relationship and your man has tons of spontaneous desire, it can be really hard to for that person to understand that you need the candles and the bath time to wind down beforehand in order to get there. It can be a little bit difficult explaining and reworking your intimate setting, but sometimes that can be the difference between a great sexual experience with or without orgasm and a poor one.
So try and figure out what things are inhibiting you and then figure out how you can work around them. It does require a little bit of effort for most people, but it typically is not super hard unless there are some complicated circumstances.
What is a normal amount of desire?
It is important to remember that there is no normal amount of desire. Desire is individualized. You have to decide for yourself if it’s low, high, or normal. It’s normal for us to have a lower desire during certain circumstances, such as right after having a baby. Unrelated to a baby, a death in the family, a change in jobs, moving, getting divorced, starting a new relationship, there are many, many things in life that can cause our desire to go increase or decrease. Those fluctuations are normal. Don’t expect to have the same amount of desire every day of your life until you die. Also, your menstrual cycle and hormonal changes cause increases or decreases in desire. So, give yourself grace with your sexual desire. You aren’t always going to feel intimate and that is 100% okay and 100% normal.
What are some tips for properly caring for our vagina and vulva?
The only thing you need for your vagina is water, which is typically abundantly flowing everywhere. There is a huge push from the commercial industry that vaginas and vulvas are supposed to smell like roses or clementine. However, your vagina should smell like the skin of your arm, not roses, not clementine, not your most recent Bath & Body Work’s purchase. It should smell like skin. If it doesn’t smell like skin, if it’s got a foul odor or something like that then you probably should visit your doctor. You do not need to put anything in it or on it to make it smell like skin. It’s so frustrating that not only do we have these pocket products that are marketed towards making your vagina smell like something it shouldn’t, but these products are being marketed to younger and younger women, including teenagers. The only thing that you need is water.
If you need to use some type of cleaning agent, say because you were recently sexually active, or maybe you’re using medication in the vagina, or you’ve recently been on your period, then you can use a very, very mild soap and very small amount only on the outside and only on the vulva. Do not douche; it actually increases the risk of certain infections. The same with putting any type of soap that’s scented or has dyes or colors inside the vagina, that can also lead to infection. Nothing inside the vagina but water outside. The best piece of equipment you can use for vaginal and vulvar health is a mobile showerhead. That way you can put water wherever you need to put it.
Is it true that pubic hair actually reduces your risk of contracting an STI?
The basic answer is no. If you look at each of the most common STIs, most of them are contracted by mixing bodily fluids and have nothing to do with hair with the exception of pubic lice. Gonorrhea, chlamydia, HPV, HIV, herpes, syphilis all have nothing to do with your hair. The most common STIs and can be passed on whether you grow hair or not.
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