Let’s talk about menopause! Let’s talk about sex! Our society has evolved from the days of old when menopause was still a taboo subject. In fact, sex was pretty much a taboo subject too! Well, our women reaching menopause are now better educated and better informed. They are voicing their psychosocial and health concerns and exploring ways and means to ensure that they maintain the best quality of life well beyond the onset of menopause. This good quality of life certainly should include enjoying an intimate and fulfilling sexual relationship with the man they love.

Menopause marks the last menstrual period in a woman’s life and heralds the transition from a reproductive to a non-reproductive phase of life for her. This was the root of the social stigma of the “dark ages” – women were made to feel that they have lost their function and femininity when they reach menopause! Menopause usually happens between 45 and 55 years of age with an average of about 50 years. In Singapore, the female life expectancy has reached 81.6 years as of 2005 and this figure continues to climb steadily. This implies that more than 30 years of life will be spent after menopause. Maintaining health in all aspects and maintaining the best quality of life beyond menopause is now one of the priorities in healthcare.

The most common sexual complaints of women after menopause include loss of sexual desire, decreased arousal or sexual response, pain during sexual intercourse, reduced sexual activity and male partner sexual dysfunction. Many of these difficulties may be related to their male partner but others may be related directly to changes due to menopause. For example, ovarian hormone deficiency results in vaginal dryness and painful intercourse, and symptoms like hot flushes, night sweats, insomnia and labile moods affect energy level and sense of well- being, thereby reducing sexual interest.

With healthcare developments and public education on erectile dysfunction as well as heightened publicity on pharmacological management options like Cialis and Viagra, men have indeed gotten a boost in achieving or maintaining their sexual prowess. Studies show that women whose partners are on these treatments for erectile dysfunction also have improved sexual desires, arousals and orgasms.

Menopause itself may bring about physiological changes which can affect sexual health. A survey of Australian women found that 58% of women had no sexual complaints one year after menopause, but by 8 years post- menopause, 80% of women would have complaints of some difficulty with sexual function. In the United States, sexual dysfunction is found to affect more than 50% of middle-aged women and the incidence increases with age. In addition, the National Survey of Sex in America found, amongst 1800 women and 1400 men, that 43% of women reported having sexual dysfunction at some time in their life, but only 31% of men reported having the same problem.

The gynaecologist may be the best person to manage symptoms like vaginal dryness and pain during sexual intercourse as examinations to assess the severity needs to be delicately conducted. For these changes, many treatment options exist. These include herbal remedies, topical treatment to improve vaginal health as well as re-adjustments of hormonal stability. Replenishing oestrogen and androgens can also serve to restore sexual desires.

On the other hand, many inhibitors of good sexual health are not as obvious or simply defined. A lack of sexual education, information about the Changes associated with menopause or access to healthcare which addresses these issues often result in women not opening up to explore options to resolve problems. Perceived ageing and declining physical attractiveness is common in a society that worships youth.

Thus, women who strive to keep and maintain their good health and fitness will be less susceptible to feel the loss of youth. In this phase of life, it is even more important to eat a sensible healthy diet, exercise regularly and see their physicians yearly for health screening.

As women become more aware and vocal of their health issues and sexual needs after menopause, their doctors should also update themselves with developments in management options. In reality, going through the sexual history of patients and talking to patients about sex may be very difficult with time constraints. However, physicians who have good communication and rapport with their patients will be able to refer their patients to the most appropriate specialists with special interests in managing menopause and sexuality, as well as sex therapists, marriage counsellors, psychiatrists or psychologists.

The most important step towards improving one’s sexual satisfaction is to talk about it. Women at or beyond menopause have matured and have survived gawky teenage years, hesitant first sexual encounters, stable comfortable relationships or even periods of sexual voids. They really have no need to feel shy about their sexual abilities or inadequacies. It is important to discuss any frustrations or indeed any desires with their sexual partners and if necessary, with their physicians whom they feel they can discuss this issue. Sexual health encompasses physical, psychological and sociocultural well-being related to sexuality. It is an important aspect of every woman’s quality of life, before or after menopause! No woman deserves to suffer sexual dysfunction helplessly and every woman should be free to express their sexuality!