Sex and intimacy in the menopause years is a complex issue. Many women have questions about living in a sexless marriage, or a lack of libido or the physical discomfort that can make intercourse painful.
These are important conversations to have, and they need an expert’s wisdom and insight to help navigate.
Selena Doggett-Jones is a relationship and psychosexual therapist. She trained as a clinical nurse specialist in sexual and reproductive health, and worked for the NHS as both a nurse and therapist for many years. We asked Selena, who now works in private practice and teaches for Relate and Tavistock Relationships, to answer some of the most frequently asked questions about relationships, intimacy, a sexless marriage and this time of life. We hope you find her answers as wise and helpful as we do.
Can a sexless marriage be a happy marriage?
Certainly it can if both partners are content without sex. The trouble comes if there is a ‘discrepancy in desire’. One partner may want sex and the other doesn’t.
This issue can be resolved to some extent if the couple are supported by a psychosexual therapist and they can discover together why one partner doesn’t want sex. This may be a symptom of other problems in the relationship and once these are explored and understood it is possible that the partner who doesn’t want sex may find that desire is reactivated. If one is asexual then this can be an issue but this would probably have been discovered prior to the marriage.
Is a sexless marriage or relationship common in midlife?
I think it can be common at all stages of life. I have seen a number of young and elderly couples who struggle to have sex.
Midlife is a time of change and reflection and sometimes people feel depressed and discouraged that they have not achieved the goals they set out for themselves. There are the pressures of career and, for some children and caring for elderly parents.
Menopause can have an effect on libido and this natural transition can have negative physiological and mental effects for some women. I don’t feel we should pathologize menopause but it has had a stigma and shame attached to it by society and that is very unhelpful.
The sexiest ingredient in relationships in many ways is ‘novelty’ so people starting a new relationship in midlife might be having a super sexy time. It is hard to keep novelty alive in long term relationships. People get lazy and forget about the need for creativity, seduction, romance and surprise.
READ MORE Menopause Libido, HRT And Sex Drive
Can you have intimacy without sex?
I believe you can. Looking directly into someone’s eyes for a minute or more for example is very intimate. We are very goal and orgasm focused in our society and often associate sex with intimacy.
You can have sex which is enjoyable or not but that does not feel intimate and you can have very intimate touching, open conversations and shared experiences which feel very intimate.
Looking directly into someone’s eyes for a minute or more for example is very intimate. We are very goal and orgasm focused in our society and often associate sex with intimacy.
Exercises set during psychosexual therapy treatment often involve intimate touching without a goal other than to stay present and complete the exercises but which do not end in sex.
How does menopause affect a woman’s libido?
Menopause involves hormonal changes that can reduce libido. It also causes physiological changes to the genitals. This can make sexual intercourse painful and arousal more challenging to achieve which naturally decreases interest. If sex is painful and not satisfying why would women want to have it?
These symptoms are very treatable so there is no reason not to have an active sex life during and after menopause. Unfortunately there is a lack of knowledge about treatments and some women are embarrassed and reluctant to seek help.
Menopause also marks the end of fertility and some women, even those who are child free by choice, can grieve the closing of this option. Others who are mothers may be facing children leaving home and their role as a mother can feel redundant to some extent.
Older women can feel undervalued in society and their confidence compromised by many years as a home maker. Restarting or returning to the work place is daunting. The ‘empty nest’ can expose a rocky relationship that may have been masked by the busyness of parenting.
These elements can reduce self-confidence and this in turn affects libido. Also, weight gain after menopause can make women self-conscious about their bodies in this media body image preoccupied western world.
How can you rebuild sexual intimacy in a relationship?
I think putting time into the relationship and effective communication is key. Sometimes I will say to clients you need to send your brain to the sex gym. By this I mean you need to make space to think about each other, fantasise, think about sex and intimacy.
Sometimes I will say to clients you need to send your brain to the sex gym.
Sex takes energy and you need to put the time and effort into it. Communication is important because if people are making assumptions, not understanding each other, feeling resentful, hurt or angry they are unlikely to want to put the time in.
Can a sexless relationship cause depression?
Yes for some people it can and at the same time a very common symptom of depression is loss of interest in sex which makes it difficult for their partners. Loss of interest in sex is often a symptom of other underlying conflict between partners.
How often should a couple have sex?
As often as feels right for them. There are no ‘shoulds’ about it. With age and certain conditions like heart disease and diabetes, blood flow to the genitals can decrease so there is something to be said for the expression, “If you don’t use it, you lose it”.
Can a relationship survive without sex?
Yes of course it can. Traumatic spinal injuries, cancer, multiple sclerosis and many other challenging conditions make conventional sex impossible but humanity is very resourceful.
If couples have a strong relationship and the will, they find ways to connect sexually and/or accommodate the changes imposed on them.
What are the side-effects of not having sex?
Sex brings blood flow to the genitals so not having sex and not masturbating reduces blood flow to the genital area. The clitoris can atrophy and the penis can become less elastic and shrink.
Sex can help reduce blood pressure and relieve stress. There is also evidence that frequent ejaculation can reduce the risk of prostate cancer in men.
A deterioration in relationships can be a side effect and non conceiving. There can be huge pressure on young couples from extended family to produce children. This can make it very difficult if there is a sexual dysfunction in the couple like erectile problems or vaginismus.
These are treatable with psychosexual therapy and/or pharmaceuticals but due to stigma many people don’t seek help.
NHS budgets for psychosexual therapy have been cut so there are long waiting lists and it is a post code lottery as to availability of these services in many areas.