Does menopause negatively impact your sexual health? We asked a doctor the questions you might be too afraid to ask

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Contact a qualified medical professional before engaging in any physical activity, or making any changes to your diet, medication or lifestyle.

Women's sexual health is a topic that's often shrouded in secrecy —especially when it comes to menopause.

Dr. Sheila Wijayasinghe, a family physician at St. Michael's Hospital in Toronto, is determined to change the narrative surrounding menopause by raising awareness about the sexual changes they may experience and providing expert advice on how to navigate it with confidence.

"As individuals transition through perimenopause into menopause, they experience just a myriad of changes that can significantly impact their sexual function that really, is multifactorial," Wijayasinghe tells Yahoo Canada.

Wijayasinghe explains that these changes are rooted in hormonal fluctuations, primarily involving estrogen, progesterone and testosterone.

Addressing the elephant in the room: Vaginal dryness

While loss of libido and vaginal dryness are two primary issues that impact women's sexual health during menopause, they're also two of the most challenging things to address with a healthcare professional due to stigma.

"It's not something that patients will necessarily bring up as a first comment. But I'll notice it when I'm about to prepare to do a pap test," Wijayasinghe says, adding that vaginal dryness is one of the "key symptoms" she manages at her primary care office.

Vaginal dryness is one of the vaginal health symptoms included in genitourinary syndrome of menopause (GSM), an umbrella term that can also include burning and stinging (dysuria), frequent urge to urinate reccurring urinary tract infections.

Wijayasinghe explains how vaginal dryness can "make sexual activity uncomfortable and painful" and can not only impact someone's quality of life, but also the quality of relationships.

In terms of libido, she says that while many people might notice a decrease in libido due to lower levels of estrogen and testosterone, others may experience the opposite; a sexual awakening.

"Some people actually notice when they transition through to menopause, an increase in libido and increase in arousal because they actually feel more confident in themselves, they are free from periods, they're not worried about getting pregnant," Wijayasinghe says.

What to do when menopause symptoms impact your sex life

Wijayasinghe says "communication is lubrication" when it comes to sexual health. Acknowledging that there are changes happening and then communicating them with your partner can "foster intimacy and lead to a better understanding of each other's needs."

Candid communication with your healthcare provider is also important in finding the best course of action in treating menopausal symptoms.

"It can be really scary to discuss this, but there are solutions that are available that can help improve your overall well being, your quality of life, and your sexual health," Wijayasinghe says.

Wijayasinghe says lifestyle factors can also have an impact on sexual health during menopause, and urged women to add exploring new forms of intimacy to the list of ways they practice self-care.

"...Exercise, proper sleep, mindfulness, relaxation techniques can all help manage stress, improve our mood, improve our self-esteem, our physical health and enhance sexual well-being," she says. "Perhaps considering exploring new avenues of intimacy, where you have a little bit of fun with it, experiment with different ways to connect sexually and emotionally."

What treatment options are there for menopause symptoms that can improve your sexual health?

When treating GSM, Wijayasinghe outlined several treatment strategies, beginning with the simplest: Lubrication. For more targeted treatment, Wijayasinghe recommended over-the-counter water-based lubricant.

"Water-based lubrications are compatible with condoms a little bit more, and they lack irritants," she notes.

An alternative to drugstore lubricants are vaginal moisturizes, specifically ones that contain hyaluronic acid. "You can use every couple of days, every two to three days, which can also improve vaginal moisture and elasticity," she advises.

One of the "mainstay" treatment options for, Wijayasinghe put her stamp of approval on for vaginal dryness is topical estrogen therapy.

"This is a form of menopause hormonal therapy — local estrogen therapy for the vagina," she says. "The treatment is delivered directly to the vagina in the form of creams, rings, or tablets that is very effective. "It helps to replenish estrogen levels locally, it feeds the vaginal tissue, and improves vaginal health."

Other treatment options include systemic menopausal hormonal therapy (MHT), which is available in the form of a patch or oral mediation and can alleviate hot flashes, vaginal dryness and discomfort during sex. Wijayasinghe says it can also help with vaginal elasticity and lubrication, to make sexual activity more "comfortable and enjoyable."

"It does carry risks, including a slightly increased risk of breast cancer and stroke,"Wijayasinghe cautions. "Systemic hormonal therapy is really made on an individual basis, considering your personal health history and the severity of your symptoms."

Many individuals may need to combine MHT with topical estrogen therapy to see the best results.

Specialists who can help you navigate physical changes of menopause

In addition to medications and MHT, Wijayasinghe suggests visiting a physiotherapist who specializes in pelvic health.

"Even investing in one or two sessions can be very helpful," she says. "Pelvic floor physios are a wealth of knowledge around the pelvic floor and pelvic floor dysfunction, and they can provide exercises and techniques to relax and strengthen pelvic floor muscles that can help reduce pain."

Sex therapy or counselling may be helpful for those who are being psychologically impacted by their physical changes.

"If sex hurts, it can be really something that can continue in a cycle and make it difficult to engage because your body's expecting it to get hurt, she says, adding that speaking with a counsellor or therapist can help manage anxiety.

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