Let’s Talk About Midlife Orgasms

As Emma Thompson’s new film shows: yes, you can still have great sex after the menopause, you might just need a little extra help to get there.

Thanks to the film, Good Luck to You, Leo Grande, female pleasure is suddenly in the spotlight. And not just any old female pleasure, but midlife pleasure and orgasms. In the film, 63-year-old Thompson plays 55-year-old Nancy, a widow who hires a male escort in an effort to recapture lost youth, and experience some of the sex she has missed.

“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 midlife," says Helen Fisher, senior research fellow at the Kinsey Institute and author of Anatomy of Love (Norton & 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. Oestrogen 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 oestrogen levels, which can make penetration painful. It’s not so much that oestrogen improves sex drive, more that we need it to keep our genital tissues in good shape.

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“I’d say that’s rather important,” says Fisher, “because things can dry up and oestrogen 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.

So, can HRT patches and gels you rub on your skin help? “Yes, they can,” 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 oestrogen-dependent tissue, so if it doesn’t have that, it won’t respond to stimulation.”

GPs in the UK will also prescribe oestrogen creams and pessaries, such as Ovestin and Vagifem, though Lynn prefers creams that 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 that 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 tissues lubricated,” says Helen Mayor, a psychosexual therapist at The Thought House Partnership.

“I was working with a 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 midlife 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 the first thing to go in the busyness of midlife, 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, more than 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, 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.”

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 oestrogen and now they’ve got a great sex life.”

Sometimes, though, it’s not hormones that are putting midlife 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 to us.

“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.”

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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 feel very sexy, because maybe they’re going out dancing rather than watching television.

“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. Gail Thorne, a psychosexual therapist with Relate, hopes that Thompson’s film might inspire some midlife 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 up 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,” says Mayor.

For some, such as Thompson’s character, midlife can prove a sexual awakening. One woman reported that she had had her first orgasm only after the menopause, as it had prompted her husband to be more attentive when intercourse became too painful.

So it’s never too late for the earth to move, or for our partner to surprise us.

The Daily Telegraph