The Good Vibrations Guide to Sex (18 page)

If the sexual side effects of menopause are causing distress, or if symptoms such as hot flashes or insomnia are worrying you, you may consider hormone replacement therapy (HRT). It would be pointless even to try to summarize the pros and cons of HRT here, as new data on its risks and benefits are published nearly every month. You and your medical professional can make the best decision based on the specifics of your own health history. If you do opt for HRT, you needn’t consider it a permanent commitment; only about 20 percent of women who start HRT stick with it for more than five years.

Perimenopause and menopause are transitional times, accompanied by numerous physiological and hormonal adjustments. Just as some women find pregnancy sexually depressing while others find it sexually inspiring, you can expect that your experience of menopause will be unique and that it won’t last forever. Menopause isn’t
the
capital-C Change that will shut the door on your vibrant sexy youth; rather, it’s one of many changes in your life that can lead you to new discoveries about your sexual self.

I’m on the road to menopause, and for a time about two years ago I experienced the complete disappearance of libido that some women report. Oddly, I didn’t experience it as loss or frustration, just as if someone had turned a switch to “off.” In a sense, it reminded me of how I felt as a child, before I started realizing that some pleasurable feelings carried a label reading “sexual.” During the libido-free time, I didn’t even miss being sexual, other than in an intellectual, “I wonder if it will come back?” sort of way. I’m pleased, though, to report that it did, in spades.

Certainly, HRT is not the only way to address the sexual side effects of menopause. Love your vulva and it will love you back. If you keep having orgasms, you’ll maintain a nourishing flow of blood to genital tissues. You can help maintain vaginal flexibility and tone with Kegel exercises, vulva massage, and masturbation with dildos. Of course, you may decide that you’d prefer to pass up vaginal penetration entirely—plenty of women of all ages have happy sex lives without it.

If vaginal dryness makes sex less fun, use water-based lubricants. Some postmenopausal women find it helpful to apply a daily lubricant (such as Replens) to nourish the vulva. Others use topical estrogen creams or rings, which are in lower dosage than estrogen patches or pills.

Testosterone levels decline at midlife for both men
and
women. In fact, a man’s testosterone levels begin a gradual decrease after young adulthood, falling to about a third to a half of their original high by the time he’s 80. Testosterone levels in women decline after menopause, but not significantly. If you have noticed declining libido, you may be intrigued by the notion of testosterone replacement. We would never recommend the casual use of testosterone patches, gels, or injections. Serious side effects from testosterone include increased cholesterol levels, sleep disorders, and liver damage, while less serious side effects include acne and increased facial hair. But we have heard reports from people who have benefited from supplements of testosterone and other androgens such as DHEA. Just proceed with caution and with medical supervision.

I’m on estrogen/testosterone hormone replacement since I hit menopause; the testosterone makes me really, really horny!

Although men don’t reach the end of their reproductive life in middle age, they face most of the same midlife sexual changes that women undergo. With increasing age, most men find that they require direct physical stimulation to attain an erection and that mental arousal or visual stimulation will no longer suffice. Many men report that erections take longer to attain and, due to reduced elasticity of erectile tissue, are less firm. It may take longer to reach orgasm, and the refractory period between ejaculations usually lengthens. The good news is that losing the sexual response pattern typical of his teenage years can be hugely beneficial to an older man’s experience of partner sex:

The nice part about getting older is being able to last a long time and choose when I want to climax, i.e., to time my orgasm to coincide with my wife’s. The downside is that my ability to perform is diminished if I’m tired or not sufficiently aroused; if this is the case, sometimes I cannot reach orgasm. Also, when I do have an orgasm, I don’t shoot nearly as far as I used to.

A few years ago I noticed that I did not get erect as easily as before. My urologist told me that I could use that for my good and my partner’s good. Many women only see the penis when it’s erect; they tend to think it’s always that way. Now my partner has the opportunity to get my penis erect, which can be very arousing for her.

I’m glad I don’t suffer from premature ejaculation anymore. And up until age 40 I used to walk around with an erection most of the time; now that’s not an issue.

Senior Sex

I don’t hear enough about sex over 60. We still like to do it, you know!

Our youth-obsessed culture treats sex as the exclusive birthright of the young, beautiful, and fit. The reality is that not only do older men and women deserve to have a sex life, chances are they’re having an altogether better one than they did in their well-toned youth.

Age brings the self-awareness necessary to a flourishing eroticism. Many women don’t gain the sense of entitlement required to name and act on their own desires until later in life. Assertiveness can open the doors to newfound passion:

I call myself a “sleeping beauty”; I didn’t discover what an orgasm was until I was 52. Before that, I had sex with my inept wham-bam-thank-you-ma’am ex-husband for 30 years. I did what I thought I was supposed to do but always woke up very grouchy the next morning. It wasn’t until I started playing around on the computer that I learned what an orgasm was. My online sexual partner was into S&M. He taught me how my nipples had a lot to do with my pleasure. So, I learned how to use a vibrator and to use rubber bands on my nipples. Wow!! A very powerful sensation occurred when I pulled a rubber band off my nipple. I never met my online partner but I give him the credit for waking me up. It took a very long time to really enjoy sex with a human being until I met my current, 62-year-old partner. Now I have the best sex I ever had. Who says old farts are dead!

Men often report that aging frees them from the tyranny of intercourse, and simultaneously allows them to explore a full-bodied, more imaginative sexuality:

As I have gotten older, I find that I do not have to get off each time in order to enjoy sex. When I was younger the physical pressure to get off was extreme but as an older person there is not the physical pressure. I’m not the “gun and run” type anymore.

One definite advantage of getting older is that it now takes me longer to come. Intercourse lasts much longer, and I can enjoy fellatio much, much longer. I have also become a more considerate lover, engaging in much more foreplay than in my younger years.

As I get older, I need more touching, more kissing, more direct affirmation that I’m wanted. Intercourse is no longer a goal in and of itself.

As you age, your repertoire of physical responses will expand. You can explore sensual massage and a range of techniques that aren’t strictly goal-oriented. Masturbation provides an excellent tool to explore how your body and its responses are changing. You may switch to having sex in the morning if you’re less energetic at night, or to having sex in the afternoon if your joints are stiffer in the morning. After retirement, you may delight in having your days free for long, leisurely sexual escapades, alone or with a partner. We ourselves cherish the dream of retiring from our labors and moving to a community house by the seashore, where we’ll sit on the porch in our rocking chairs, surrounded by friends, with vibrators and lubricants close at hand.

When I was younger, physical conquest was the objective. Today, it is more an intellectual melding…. Today I find that “going to bed” starts much earlier in the day, involves more sweet connections beforehand, and is a warmer joining later. Although much less intense now, sex today is much more satisfying.

Disability

The sexuality of people living with disabilities is all but rendered invisible in our society, but you’d better believe that men and women with disabilities are sexually active. And they’re exploring varieties of erotic response that all too many able-bodied folks miss out on.

Sexual expression among people with disabilities takes many different forms, just as physical limitations take many different forms—varying not only from one disability to another, but also from one individual to another. If you have spinal cord injury, you may or may not experience genital sensation, erection, or orgasm, but you don’t lack for erotic sensation. Nipples, necks, and ears can be highly responsive erogenous zones.

Since the accident, my orgasms are different than they used to be, though it is hard to describe or qualify them to someone else. There are places on my body that are much more highly sensitized (like the inside of my thighs, my neck, my tits)—I think to compensate for where I have less feeling (like on my butt). Fortunately I can still feel my clit and pussy.

It’s possible to focus so intently on touch in one part of the body that it feels exquisitely as though the entire body is being touched. Orgasm is as much an experience of the mind as the body. While the stereotype is that people living with disabilities default to oral sex (which, needless to say, can be a huge source of sexual satisfaction for those with and without disabilities alike), mobility issues don’t necessarily preclude intercourse—or becoming a biological parent.

If you have a disability, spontaneity is not always an option, particularly if intercourse is involved. You and a partner may need to make preparations for a sexual encounter, whether making sure bladder and bowels are empty or ensuring that you have ample time and privacy. But the rewards are obvious. Simply navigating the logistics of daily life can be so physically stressful for people with disabilities that the chance to relax into an erotic exchange can be particularly precious.

My sexual experiences changed when I became disabled (paraplegic) at the age of 25 as the result of a spinal cord injury. I really needed to do a lot of sexual exploration after that. I have an incomplete injury and still have genital sensation. I still am easily aroused and experience desire pretty much the same, but the objects of my desire are different: I now have to feel comfortable with, not just attracted to, the one I desire.

People with physical disabilities benefit from an articulate activist movement, but those with developmental disabilities tend to lack community empowerment. Well-intentioned parents and caretakers usually deny the sexuality of individuals with developmental disabilities. At the same time, men and women with developmental disabilities are particularly vulnerable to sexual abuse, and advocates estimate that anywhere from 30 to 90 percent of those in group homes or residential facilities are sexually abused, usually by staff. People with developmental disabilities have the right to adult sexual and romantic relationships. Advocates for sexual rights have began to create training and education tools, such as classes on sexual anatomy, masturbation, communication, and abuse prevention.

For a far more comprehensive discussion of this topic, we heartily recommend
The Ultimate Guide to Sex and Disability
by Cory Silverberg and Miriam Kauffman. See our resource listings for other publications and websites related to sex and disability.

Medical Issues

Anything that affects your physical health and ability is going to affect your experience of sex, yet illness need not slam the door on your sex life; in fact, if you listen to your body, it may
open
the door to a whole new range of pleasures. If the debilitating pain of arthritis makes sex seem unappealing, take the time to warm up your joints with a warm bath, a massage, or gentle stretching, and experiment with different positions to find those that are more comfortable.

A heart condition may make you leery of sexual activity—but the good news is that if you can handle normal physical exertion, such as climbing stairs, it’s perfectly safe to have sex. Studies have found that the risk of having a heart attack during sex are comparable to the risk from getting out of bed in the morning (so stay in bed and have sex!)

High blood pressure (and the accompanying medications) and adult-onset diabetes can produce erection problems—we address some recommended coping mechanisms in the Sexual Anatomy 101 chapter. Women with diabetes can experience loss of vaginal lubrication and sensation, which can be ameliorated with lubricants, vulva massage, and playing with vibrators.

If you have a chronic illness, you’re familiar with the challenges presented by limited energy. Open communication with a partner becomes more crucial than ever.

I’m HIV-positive, and during a low T-cells week, I fell asleep in the middle of hot sex with my partner—ouch. Have recovered with help of medication. Now I can have sex in the evening again. For awhile had to be in the morning only. My partner was very understanding. But it’s been hard to lose the “sex is always there to do” feeling and know this life won’t go on forever.

I tend to go through spurts. I am a sex fiend one day, and I couldn’t want sex less the next. This is due to my problems with my thyroid gland and depression. It’s a horrible feeling, knowing that you don’t want the person you love more than anything to touch you—wishing that you could make love to him, but your body just isn’t willing. I still love sex and I love my partner, but sometimes my body chemistry gets in my way.