1) What are some of the possible effects of menopause on sexuality? What sorts of things can folks expect and what are some ways to respond to them?

Many women experience hot flashes, night sweats, sleep deprivation, and mood swings – which sometimes feel like PMS on steroids! – and who can get in the mood for sex with all that going on? Trust me – it gets better after menopause, once your system calms down and adjusts to hormonal changes. Meanwhile, communicate clearly with your partner and your family, and try to take time for yourself – a “pause” – while you’re going through this emotional and physiological upheaval.

Once the extreme changes have ebbed, the ongoing challenges from diminishing estrogren at menopause and beyond include decreased vaginal lubrication and thinning of the labia and vaginal tissues. These changes can result in painful intercourse, a burning or stinging sensation, or even tearing. In addition, we may take much longer to become aroused and, after arousal, to reach orgasm.

For both of those challenges, it’s crucial to use a good, slippery lubricant. Even if you think you’re wet enough, your natural lubrication has changed – it’s thinner and less protective for your more delicate tissues. So experiment with a slick lube that feels good and doesn’t dry out or get tacky quickly. Personally, I love both Liquid Silk, which feels most like natural lubrication and stays moist through prolonged sex, and Eros, which is very slippery and comfortable.

Never use Vaseline, baby oil, cooking oil, or other greasy stuff you might have on hand. These are difficult to clean out of your vagina and can cause irritation or even infection. Use a lubricant made specifically for sexual comfort and pleasure.

You can buy samples of several different lubricants to find the one(s) that you and your partner prefer. Rather than being embarrassed about needing lubricant, make it part of your sex play by letting your partner apply it gently with caresses.

2) What are some of the relationship changes that people going through menopause might be dealing with? How might they choose to address them?

The hardest part is talking about it. If you feel less sexy, or more self-conscious about your aging body, or frustrated with your changing sexual responses, talk to your partner and plan ways that your new needs can be incorporated into your love play. For example, you may need to communicate that you need longer foreplay, with more whole-body touching before your lover arrives at your hot spots. You may need to change the time of day that you have sex to times that you feel a combination of relaxed and alert – maybe morning, maybe late afternoon.

It’s also helpful to do other physical activities together, such as dancing, hiking, working out or even walking the dog. Being physical together – even when the activity is not specifically sexual – can lead to a enhanced body awareness and closeness. Exercise also increases blood circulation, which – ahem! – sends more blood to your genitals and brain as well as to your muscles! You may find that you feel sexier after exercise, more open to sensual exploration, so make use of it!

Realize that as our biological drive gets less urgent, we may find that leisurely sex is more satisfying than the frantic sex that was so exciting in our youth. Even something as simple as making love in the daytime instead of after dinner (I find I can’t digest and have satisfying sex at the same time!) may make a huge difference.

3) Are there specific sexual products that might be useful or fun for women experiencing menopause and/or their partners?

Oh yes! Here’s where a sex toy can be your new best friend. If you’re experiencing decreased sensation – a touch that used to set off fireworks in your brain and genitals now barely lights a spark, for example – try using a strong, plug-in vibrator for your clitoral stimulation. My personal favorite is the Eroscillator (I wrote about its pleasures at length in Better Than I Ever Expected: Straight Talk about Sex After Sixty!), and I also enjoy the Acuvibe.

If your partner is a man who resists sex toys, let him watch while you pleasure yourself and ask him to participate by kissing you, holding you, and touching you. Let him run the vibrator over his nipples and genitals, if he wishes. Encourage a “threesome” – the two of you and the vibrator – so that he doesn’t feel “replaced.”

4) For women who want to talk to their doctors about menopause and sexuality, what are some ways to bring the topic up? What questions might they ask?

I wish doctors would automatically ask, “Is there anything about your sexual response that you would like to ask about?” But since few do this, please take it on yourself to bring up the subject.

It’s crucial to describe any changes in sexual response to your doctor, not just to live with diminished pleasure. Your doctor may want you to go on HRT, or use the estrogen ring or cream, or take a testosterone test to see if you need that hormone, which also affects sexual response in women. Sometimes changed sexual response can be a sign of another problem – a medical condition that needs to be addressed, or a drug interaction that can be resolved with a change of medication. Find out what’s going on with you. Encourage your partner to consult a doctor about his or her changing sexual responses, also.

If your doctor seems unwilling or unable to help you, ask for a referral to another health professional. I’ve had terrific advice from a nurse practitioner at a major HMO – she keeps up to date on the research, and studies my medical history to give me personalized advice.

5) Do you have advice regarding hormone replacement therapy (HRT)?

I don’t give medical advice, and my personal experience should never be confused with scientific proof that something works. Even if something does work for me, or for your best friend, that doesn’t mean it will work for you, or that it won’t have undesirable side effects or interact with a medication you take in a way you don’t expect. Please consult your own healthcare provider to find the best medical or alternative solution for you. Tell your doctor about any herbs or supplements you are taking, because they may have effects you don’t realize.

Women can now expect to live an average of eighty-two years, which means that women will now live one third of their lives postmenopausally, points out Sheryl A. Kingsberg, Ph.D., a sex researcher.

We all need to make our own decisions about HRT and alternatives, and what to do about the effects of dwindling hormone levels. We’re all different, and we can’t know for sure whether, in our individual case, HRT is good for us or bad for us, and which type/combination/brand might be better or worse.

For now, I’m happy using only an estrogen ring internally to thicken the vaginal skin so I don’t tear, and lubricant for comfort during sex. My nurse practitioner tells me the effects of the ring are local and are thought not to affect the rest of the body.

We’re offended by outdated stereotypes of asexual older women, and we’re not going to hide behind them at this time of our lives. Specifically, we’re not going to roll over and play dead when our private parts are concerned. Admittedly there are problems with sex after menopause, but we can adjust to our post-menopausal changes without losing our sexy zest.

Juicy is an attitude, I’ve come to realize, based not on the flow of our vaginal secretions but on physical well-being, emotional state, mental attitude, and love of sex. Here’s to post-menopausal zest – and understanding lovers!