Sex and Menopause: Thawing (Boiling?) the Big Chill

Turning menopause into an opportunity for sexual intimacy
Published on April 7, 2011 by The Psychoanalysis 3.0 Writing, Group in Psychoanalysis 3.0


Sex after menopause is not just about loss; it can also be opportunity: for growth, healing, pleasure, and satisfaction. Of course, menopause is not an easy transition for many women. It can be a time of mourning; a time of taking stock and facing old age and death. But it also is a time in a woman’s life when she can try something new—do things differently. And sex can play a big role in successfully navigating menopause.

In my clinical work, I’ve been developing a two-part treatment approach that is working well with menopausal women who are unhappy with the quality of their sex lives. This approach has been particularly effective with women who express a dread or fear of sex at menopause.

Decline of interest in sex is a common and highly disturbing problem for many menopausal women. Some patients have said they would choose to give up sex altogether if it were not for their partner’s objections. Many of the patients I’m talking about are women who came of age in the late 60’s and early 70’s and describe themselves as having been sexually liberated and experimental in their late teens and twenties. A number of them are in relationships, some straight, some gay, and remain joined to people with whom they once had a vigorous and satisfying sexual relationship. Since entering perimenopause they have become less interested in and more avoidant of sex.

There are a variety of reasons why a woman might give up sex at menopause: as the sex hormones decline, there is an accompanying decline in libido; both men’s and women’s bodies are less attractive as they age; sex becomes physically more difficult for both men and women.  But physical symptoms are not the whole story and there are a variety of medications to treat both female and male sexual problems.

On the other side of the equation, changes in lifestyle would actually seem to facilitate freer sex: in many cases the children are now living out of the house; the stresses of early adulthood are lessening; and, of course, there’s less or no need for birth control. But just as external conditions increasingly facilitate sexual activity, some women become fearful and anxious about sex.  To work through that fear seems daunting, even impossible.

For many women the decline in sexuality is not only problematic but difficult to address due to the shame attached to it.  Often, a menopausal woman comes into treatment with issues unrelated to sex, most often depression.  The emergence of the problem of declining sexuality is accompanied by a sense of embarrassment and futility.

The 2-part treatment approach I have been developing is simple, straight-forward and assumes that the sexual problem may, in part, have its roots in earlier dissociated sexual trauma. Trauma can be defined in many ways and what is experienced as trauma by one person may not be traumatic for another. The type of sexual trauma resulting from experiences that were thought of as adventures at the time is particularly prevalent in women who came of age during the sexual revolution of the late 1960’s and early 1970’s, women who are now in menopause.

In the first phase of the treatment I take a very careful detailed sexual history. In particular, I focus on experiences that may have seemed like adventures at the time but are now felt to be painful, traumatic humiliating events.

There’s an expression, “If you remember the 70’s, you didn’t experience it.”  That is, those who were really living the 70’s were too high on drugs to remember it.  I believe it also speaks to the dissociation of this time of sexual experimentation, particularly for women. Common experiences for adventurous young women during this time included having sex while under the influence of powerful drugs such as Quaaludes, speed or LSD; waking up in bed with someone you did not know; rape; date rape; abortions; sado-masochistic relationships; and being involved in cult-like groups where women had multiple sex partners.  Such experiences were more common than we might think today.  The Harrod Experiment  (1966), and The Electric Kool-Aid Acid Test (1968) provide accurate descriptions of sex among the more daring young women of those days.  Of course, women who were not adventurous also may have experienced sexual trauma that was dissociated.

What is most interesting is that these “sexual adventures” may not have been experienced as painful, humiliating or traumatic at the time they occurred.  It is only in retrospect, going through the changes of menopause and experiencing sexual difficulties that these events take on a traumatic feeling.

The second phase of the treatment focuses on contacting and articulating thoughts and feelings that are erotically compelling to the patient—to facilitate reconnection to her sexual desires.  One could call this a detailed inquiry of eroticism.  It requires some degree of courage for a woman who has become anxious and phobic about sex—even disconnected from sexual desire—to talk about the sexual fantasies, masturbation practices and sexual experiences that have been arousing to her. However, I have found patient, slow persistence creates a climate in the therapeutic relationship where such things can be discussed openly.

For example, Harriet, a 54-year old patient, had developed a dread of sex and had started to avoid sexual contact with her husband. After taking a sexual history that revealed a great deal of dissociated trauma, I began asking her to think about and tell me what turned her on. I asked her if she masturbated (she did) and whether she used a vibrator (she didn’t).  I questioned whether she enjoyed pornography and what kinds of scenarios she found arousing. These questions were hard for me to ask because they aroused shame in her, and were difficult and embarrassing for Harriet to answer.

One day she brought in a Victoria’s Secret Catalog and we went through the pages together as she explained what was sexy and what was not.  She had always thought black underwear was sexy. Maybe she should buy a few pairs. She bought and wore them and reported that they did indeed make her feel different.  She felt sexy but it was hidden—no one knew but her.

As we continued to explore her sexual thoughts and fantasies she started to experiment with initiating sex with her husband, tentatively and with a great deal of anxiety. She talked about her fears with her husband. He was sympathetic and patient and their intimacy increased as she shared negative experiences with him. After a while it became easier and less scary. Eventually, their sexual relationship improved to a point beyond what it had been when they were first together, making them feel closer than they had felt in years.

Menopause is not an easy transition for many women. Taking stock of one’s sexuality is often part of this transition. Some women gradually lose interest in sex as they approach menopause and eventually give it up altogether.  For others, this is a time when dissatisfactions with their sexual relationship come into focus. But it also is a time in a woman’s life when she can try something new—do things differently and become the author of her own desire.

[This article is adapted from “MENOPAUSE AND SEXUALITY” that appeared in Contemporary Psychoanalysis, 45: 26-43.]