All through their lives, both men and women experience hormonal changes, but never are the shifts more challenging than in midlife. For women, falling estrogen levels result in a host of uncomfortable symptoms: hot flashes, sleeplessness, weight gain, anxiety and depression, and — often overlooked — vaginal dryness and irritation. The medical term for the latter is vulvovaginal atrophy or VVA.
Even for women, those symptoms can come as a shock, and women often feel like few men understand what they’re going through. Even the strongest couples may struggle with the changes, and talking about menopause with your partner can be hard. Perimenopause (the years leading up to menopause) can feel like a crash course in biology and physiology that you didn’t realize you’d signed up for — and it behooves both men and women to educate themselves.
Hot flashes are self-evident, and it’s difficult to miss a mood swing, but vaginal discomfort is a symptom a partner cannot see — and it’s not something very many women talk about. In fact, one in four women don’t tell their partners about their discomfort, because they consider it just a natural part of growing older (in other words, not worth mentioning). One in five are too embarrassed to discuss it, and more than a quarter are worried it will ruin the cherished intimacy they have developed with their partners, sometimes over many years.
However, a 2017 report that appeared in Sexual Medicine Reviews found that the vast majority of men surveyed (82 percent) said they do want to know about their partner’s distress — vaginal and otherwise. And more men than women said they would be comfortable discussing such matters with their partners. Men were more likely to say they avoided intimacy (76 percent) and had less sex (61 percent) because of their partner’s vaginal atrophy than their female partners. But they were less likely to report diminished sexual satisfaction (28 percent compared to 49 percent).
Truths and Lies
1. Men and women have different perceptions of menopause.
TRUE: When surveyed, men described the symptoms of menopause as hot flashes, lack of libido, and depression. Women included a whole range of other problems, both physical and psychological: transient changes in memory, vulvar and vaginal dryness and itching, and soreness during and after sex that often lasts for days (and often despite being aroused).
2. Age-associated changes in women’s bodies can be fixed with hormone replacement therapies.
FALSE: HRT is neither fountain of youth nor time machine, and long-term HRT is no longer routinely recommended because it can increase the risk of blood clots and some cancers.
3. Women who have been treated for certain conditions, including hormonally stimulated cancers (breast, uterine, ovarian, cervical) and skin conditions (such as scleroderma and lichen planus) experience early menopause and postmenopausal problems for a longer period of time.
TRUE and FALSE: Early onset menopause does occur with certain conditions. However, it doesn’t have to result in a lifetime of problems if preventive treatment strategies are consistently applied.
4. Loss of libido is psychological. Women are just depressed about getting old.
FALSE: A lower sex drive is the result of changing hormone levels. (Some women experience a ramped-up sex drive during perimenopause or after.) Decreased hormone levels can also lead to other changes that make a woman less interested in sex. Vaginal dryness and tightness are two. Fatigue and sleeplessness are two others. Put it altogether, and you’ve got a recipe that feels more maddening than sexy.
5. Erectile aids make for better sex.
TRUE and FALSE: Enhanced erectile function can improve the sexual experience for both partners. However, repeated penetration during extended or frequent intercourse can leave a menopausal woman’s vagina tender for days. A woman needs help beyond that of a sexual lubricant. As we age every part of our skin becomes drier, and we need to constantly moisturize to keep skin resilient and supple. The vagina is no exception.
Talking About Menopause
So what should a couple do?
First, talk. And listen. Engage with each other’s feelings, both physical and emotional. Aging is nothing to be embarrassed about. It happens to everyone, and it helps to share the experience with your intimate partner. Start the conversation and keep it going.
Second, get help if you need it. See a physician together or find a therapist who is experienced in the challenges of couples who are growing older together.
Third, make joint decisions about treatment and lifestyle changes. Figure out what you each need and then get on board with lovingly giving that to each other. Invest in self-care and support your partner in his or her self-care as well.
And most importantly, continue to enjoy each other. Menopause isn’t a time for secrets — it’s a time for sharing.