Emma Thompson and Daryl McCormack in Good Luck to You, Leo Grande. Photo / Searchlight Pictures via AP
A new film shows a 63-year-old having the best sex of her life, but is this realistic? Sharon Walker asked the experts.
As Emma Thompson's new film shows, you can still have great sex after the menopause, you might just need a little extra help to get there.
Female pleasure is suddenly in the spotlight, thanks to Thompson's new film, Good Luck To You, Leo Grande. And not just any old female pleasure, but mid-life pleasure and orgasms. In the film, 63-year-old Thompson plays a widow, Nancy, who hires an escort in an effort to recapture her lost youth and experience some of the sex she has missed out on.
"Some nuns have had more sex than I have," she laments. Nancy's sexual awakening is a delight to watch, as she presents her young beau with a list of "goals". But what about for the rest of us? Can sex really get better with age, or is it all downhill after the menopause?
"There are three things that could make sex a lot better in mid-life," says Helen Fisher, senior research fellow at the Kinsey Institute and author of Anatomy of Love (Norton and Co).
"You've got more daring and sophistication, so you can tell people what to do and you know your body better and what makes you orgasm. But then there's also the physiological side. Estrogen drops dramatically, testosterone declines, but not as much. The body is expressing more testosterone, so it's entirely possible to maintain sex drive. Testosterone is why older women become much more assertive and why they put weight on around the middle the way men do but also means they can remain extremely sexual."
That said, many women will still need hormone replacement therapy to supplement plummeting estrogen levels which can make penetration painful. It's not so much that estrogen improves sex drive, more that we need it to keep our genital tissues in good shape.
"I'd say that's rather important," says Fisher, "because things can dry up and estrogen keeps everything youthful and supple."
Orgasms can become more elusive after the menopause, with many post-menopausal women finding it harder to climax and less satisfying when they do.
"Estrogen is the gas that makes the car go," explains US gynaecologist, menopause expert and psychosexual therapist Dr Becky Lynn.
"So if you're trying to reach orgasm and you have your foot on the accelerator but there's no gas in the car, it's going to be very hard to get there. Lots of things can prevent orgasm, it's not always lack of estrogen, but post menopause that's the most common thing and the easiest to treat."
So can HRT patches or gels you rub on your skin help?
"Yes they can help," says Lynn, "But, and I stole this quote from a colleague, it's like the vagina is the last stop on the train. So when I'm treating vaginal dryness or orgasm problems due to menopause, I will treat locally. I have women rub a little cream directly on the clitoris. The clitoris is an estrogen-dependant tissue, so if it doesn't have that it won't respond to stimulation."
UK GPs will also prescribe estrogen creams and pessaries, like Ovestin and Vagifem, though Lynn prefers creams which you can rub on the sensitive areas.
Some women benefit from introducing a vibrator. "Sometimes post menopause you need more stimulation and that's hard to do with fingers or mouth," says Lynn. "But then some women become more sensitive, so it's complicated." For those still having issues, Lynn recommends checking out the website OMG Yes for techniques.
Or it could be the pelvic floor needs a good workout, as being able to contract and relax the pelvic floor makes for pain-free penetration and also promotes blood flow to improve orgasm. "You have to keep the muscles working and keep the muscles lubricated," says psychosexual therapist at The Thought House Partnership, Helen Mayor.
"I was working with one woman who was fuming about the menopause and was really mourning her sex life. She was taking every drug going - HRT, testosterone - she was fantastically driven and saw an array of therapists. In the end she went to see a pelvic floor physio and it was the pelvic floor exercises that really helped her with feeling sexual and with the ease of the orgasm."
Of course not every post-menopausal woman will experience sexual setbacks and many relish the new freedoms mid-life brings. They no longer have to worry about contraception, or the teenage kids hearing them, and they can make use of every room in the house. But sex is often first thing to go in the busyness of mid-life, as research shows. Figures from the National Survey of Sexual Attitudes and Lifestyles, 2012, which is done every 10 years, showed that of 15,000 women aged 45-59, over a third had been sexually inactive, though only one in six were actually dissatisfied.
When the researchers interviewed the women to find out why they'd stopped having sex, most were simply too tired. "They were just beleaguered," says Kaye Wellings, a professor of sexual and reproductive health at the London School of Hygiene and Tropical Medicine, who conducted the research.
"They were that generation sandwiched between having children later in life and having parents who were getting older. What was more important than sex for them was a partner who was on board with helping them and supporting them with all the demands."
But just because you've made peace with the sexual Sahara, your partner might not feel the same, Lynn warns. "You might think, 'Oh he's doing fine,' because he's not asking you to have sex. But he could feel rejected."
Lynn recalls one couple who were on the verge of breaking up as the wife didn't want sex and the husband had strayed. "We put her on testosterone for low libido and vaginal estrogen and now they've got a great sex life."
Sometimes though it's not hormones that are putting mid-life women off sex but the sheer boredom of a long-term relationship, or having a partner who drinks too much, who works too hard, or who just isn't very nice.
"Now I'm going to say something very unpopular, which is that for an awful lot of middle-aged women, if they just got a different partner, their sexuality would return," says Fisher. "The problem is not so much with sex, it's with boredom."
Fortunately, though, there's no need for drastic action, or calling on the services of a young escort. As long as the sex works and you're basically happy with it, there's plenty you can do to reignite the spark.
"What I would do is spice up the romance (rather than the sex)," says Fisher. "Do novel things together, novelty drives up the dopamine system in the brain that triggers the testosterone system, and can really help with sex drive. That's why when people go on vacation together, they can suddenly be very sexy together, because maybe they're going out dancing rather than watching TV.
"Even going to a new hotel and figuring out how to turn on the shower can be sexy because it's novel. And then the same old sex feels more exciting because you're amped up for it."
That's not to say that you shouldn't try mixing it up in the bedroom. Relate psychosexual therapist Gail Thorne hopes that Thompson's film might inspire some mid-life couples to focus more on the intricacies of female pleasure, rather than seeing intercourse as the main event. "Penetration is not the be all and end all for most women," says Thorne.
"Women are much more turned on by luscious kissing, oral sex and genital stimulation and that all works really well when there may be some changes to her anatomy as a consequence of the menopause."
After 20 or 30 years together most of us have a well-honed script, but it's never too late to introduce new fantasies, says Mayor. You might think, "Oh my partner wouldn't like that," but we could easily be wrong. Most of us think we know our partners inside out, but the chances are we don't really.
"When I was training, a couple came after he'd had an affair. He had all these things he wanted to do and just didn't think the mother of his children could possibly be up for all that. But she was up for it all.
"As therapists we have a whole list of different things and one of the exercises is asking: 'What do I think he would like?' 'What would I like?' 'What would I be up for trying?', so it opens the possibility of trying new things. Some people want to watch ethical porn and experiment with BDSM. Others are very happy with their three sexual positions."
For some, like Thompson's character, mid-life can bring a sexual awakening. One woman reported that she had had her first orgasm only after the menopause, as it had prompted her husband to raise his game when intercourse became too painful.
So it's never too late for the earth to move or our partner to surprise us.
1. Spice up your romance. No need for chandelier-swinging theatrics. Anything NEW will do. Go wild, try the local Italian restaurant instead of your usual Indian. Novelty will amp up dopamine and testosterone, which will make you fancy your partner
2. Bin your favourite oh-so-comfy jogging bottoms that you've been wearing since the first lockdown. No arguing. Trust us on this one
3. Focus on outercourse over intercourse. Less thrusting; more smooching and licking
A sex educator has answers on the ins-and-outs of sexual intercourse.