Sex menapause

Aging & Sex; Menopause, Libido & Looking After Yourself

In the years around menopause, you may experience changes in your sexual life. Some women say they enjoy sex more because they don’t have to worry about getting pregnant. Others find that they think about sex less often or don’t enjoy it as much. Changes in sexuality at this time of life have several possible causes, including:

  • Decreased hormones can make vaginal tissues drier and thinner, which can make sex uncomfortable.
  • Emotional changes can make a woman feel too stressed for sex.
  • Decreased hormones may reduce sex drive.
  • Body image can be a problem because of an increase in body fat, especially around the abdomen, which can occur because of hormonal changes.
  • Night sweats can disturb a woman’s sleep and make her too tired for sex.

Seek advice from a professional if you need help with any sexual problems, and speak to your doctor about hormone replacement therapy, oestrogen creams, tablets and pessaries, all of which may help.

You are not alone 

Rarely or never sensing a desire to engage in sex is the most common sexual concern among women. It is estimated that approximately 30% to 40% of women are affected by low or absent sexual desire.

Other sexual health issues

Women can experience a number of sexual problems including dyspareunia, where sexual intercourse is painful, and vaginismus, where the muscles of the pelvic floor spasm.


Dyspareunia, or painful sex, can result in loss of interest in sex and relationship problems, and it can affect your mood. It’s a term used to describe pain before, during or after vaginal intercourse. Getting a diagnosis of what is causing the pain can help you identify the most effective treatment for you.

What causes it? 

  • Lack of lubrication: this can be caused by hormonal changes and lack of arousal.  Inflammation, infection or skin disorder: infections of the genital area or urinary tract can cause painful intercourse.
  • Illness: a number of illnesses or conditions, such as endometriosis, ovarian cysts and prolapse, can lead to painful sex. 
  • Scarring: scars from surgery in the pelvic area can cause painful sex. 
  • Vaginismus: a condition where the muscles in the vagina spasm. 
  • Emotional causes: a history of trauma, stress and anxiety can all make the problem worse. 

What you can do: Make an appointment to have a pelvic examination. This is a physical examination where your doctor will check for signs of infection, irritation or any anatomical problems. A pelvic floor physiotherapist may also be recommended.


Vaginismus is an extremely distressing condition. It involves an involuntary spasm or contraction of the muscles surrounding the entrance to the vagina, making penetration impossible and/or painful. For most women it happens completely unexpectedly, like an automatic reflex. It is important to remember that vaginismus is not due to a physical abnormality of the genitals. The muscles have, for some reason, developed an automatic response to penetration.


Vaginismus does not get better on its own. Pelvic floor physiotherapy can often help by using techniques such as trigger point therapy (identifying pain that is related to a discrete point) and gentle soft-tissue massage in the pelvic area and in the vagina.

Sexual counselling is also recommended, especially if trauma or abuse could be a factor.

FACT: Dyspareunia affects between 5% – 17% of women globally.


Pelvic inflammatory disease (PID) is an infection of the uterus (womb), fallopian tubes and/or ovaries in women.

What causes it? 

It’s transmitted through unprotected vaginal sex or from surgical gynaecological procedures, such as a termination of pregnancy. PID is often caused by chlamydia, especially in women under 30 years of age. Other bacteria may also be involved, including normal vaginal bacteria and those that cause gonorrhoea. 

What are the symptoms? 

Some women with PID have no symptoms and many have only mild symptoms, which often go unnoticed. 

How is it treated? 

Without treatment, PID can lead to serious problems like infertility, ectopic pregnancy, and chronic pelvic pain. Your doctor will prescribe antibiotics to treat PID.

FACT: PID is the number one cause of female infertility.


Cancer of the cervix is the second most common cancer experienced by women worldwide. Cervical cancer starts in the cervix, the lower, narrow part of the uterus. It happens when the cervical cells divide very fast and grow out of control.

Thanks to regular screening tests and vaccination, cervical cancer is now the most preventable gynaecological cancer. It is also very curable when found and treated early.

What causes it? 

Almost all cases of cervical cancer are caused by infection with some types of HPV; this is the biggest risk factor for cervical cancer. The other main risk factor for cervical cancer is smoking. The HPV virus infects the surface cells of the genital area including the cervix, vagina, vulva and anus, and can also cause visible warts.

There are two different types of HPV vaccinations available in South Africa, for more information on cervical cancer and the vaccinations, visit

FACT: 9 in 10; the number of cervical cancer cases that can be prevented by regular Pap smear tests.


The vulva is a general term used to describe a woman’s external sex organs. Cancer of the vulva is not common, but because many women don’t examine their vulva, they don’t know what is normal for them and may not notice changes that need further investigation.

What are the symptoms? 

If you feel any pain in your genital area or notice any of the symptoms below, you should make an appointment with your doctor. You may have one or more of the following:  

  • A lump, sore, swelling or wart-like growth on the vulva. 
  • ltching, burning and soreness or pain in the vulva.
  • Thickened, raised, red, white or dark-brown skin patches. 
  • A mole on the vulva that changes shape or colour.


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