Orgasms after menopause

[Watchkeys]

My partner cannot orgasm. She's post menopause, and menopause is clearly what's caused the problem. Has anybody been in this position, and if so, how did you deal with it?

@JinglingHellsBells apologies if I didn't explain it clearly enough.

Some GPs who have sufficient menopause knowledge including use of testosterone as part of HRT are I know prescribing this to women on the NHS.

The NICE Menopause Guidelines 1.4.8 states "Consider testosterone supplementation for menopausal women with low sexual desire if HRT alone is not effective." and includes a link on prescribing medication that is off label or off-license which is a useful read.

It's a little similar to the guidelines section on urogenital atrophy where it states: "If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause." Some GPs will increase this but others will refer to, for example, a menopause clinic. A lot are unaware that local estrogen has previously been approved at a higher dose (vagifem) but that's another story.

The BMS has useful tools for clinicians - this one on testosterone thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/

Also a factsheet for women here that states: "Testosterone can be prescribed on the NHS if the prescriber is familiar with it and is willing to prescribe it ‘off licence’. Some clinicians prefer not to take this decision and to refer to a specialist for advice before prescribing. Other clinicians will have prescribing restrictions, which mean they are not able to offer it" the last point which should be noted as it will depend on each area drug formulary.
www.womens-health-concern.org/help-and-advice/factsheets/testosterone-for-women/

Ideally all clinicians in charge of our menopause care would be well informed, something that is being strongly pushed for.

[quote over50andfab]@JinglingHellsBells apologies if I didn't explain it clearly enough.

Some GPs who have sufficient menopause knowledge including use of testosterone as part of HRT are I know prescribing this to women on the NHS.

The NICE Menopause Guidelines 1.4.8 states "Consider testosterone supplementation for menopausal women with low sexual desire if HRT alone is not effective." and includes a link on prescribing medication that is off label or off-license which is a useful read.

It's a little similar to the guidelines section on urogenital atrophy where it states: "If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause." Some GPs will increase this but others will refer to, for example, a menopause clinic. A lot are unaware that local estrogen has previously been approved at a higher dose (vagifem) but that's another story.

The BMS has useful tools for clinicians - this one on testosterone thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/

Also a factsheet for women here that states: "Testosterone can be prescribed on the NHS if the prescriber is familiar with it and is willing to prescribe it ‘off licence’. Some clinicians prefer not to take this decision and to refer to a specialist for advice before prescribing. Other clinicians will have prescribing restrictions, which mean they are not able to offer it" the last point which should be noted as it will depend on each area drug formulary.
www.womens-health-concern.org/help-and-advice/factsheets/testosterone-for-women/

Ideally all clinicians in charge of our menopause care would be well informed, something that is being strongly pushed for.[/quote]
@over50andfab I don't think what you posted says anything different to what I said. The reality is that most GPs cannot prescribe it either through lack of knowledge or an unwillingness to go outside of licensed treatment.

Most know very little about standard HRT let alone testosterone!

The BMS link , as I read it, is aimed at consultants, not GPs as it expressly says it is not licensed and that few drs without specialist training can prescribe it.

@JinglingHellsBells, true, I do a lot of work in supporting women in this area and can share experiences that some women are able to access this via their GP though many cannot and some will not even refer. This is getting better though with some women being pleasantly surprised.

In practice some GPs might wish to prescribe it but are unable to do so as their drug formulary prevents it. GPs often prescribe medications for drugs that are off license but are proven to work in a certain area and are allowed to do so under certain conditions including where it's necessary to meet the needs of the patient.

The NICE guidelines are aimed at anyone with an interest which includes women, GPs, and any other clinicians. The BMS link is aimed at clinicians which can include GPs with knowledge of menopause. I agree, it is about specialist training and the hope is that all GPs will have this. From personal experience my GP is really well informed, however it would be helpful if all gynaecologists were too!

Are you all saying that you require an orgasm EVERY TIME you have sex???? I certainly don't and ive got a pretty high sex drive

Yes!! I would be disappointed not to tbh. In fact XDP used to spend half an hour at least making sure I had multiple orgasms before he allowed himself to get carried away as he knew he was good for nothing after he’d had his!

I used to think like @Anothernick until I met a guy with whom I was sexually compatible and extremely good in bed, and changed my mind. Now I wouldn't go back to not having orgasms the majority of times for all the love in the World.

Interested that some people advise the OP to discuss with her GP. I can't imagine for a second that they would be interested, helpful or even willing to listen to people talking about unsatisfactory sex. People with suspected cancer can barely get an appt.

I don’t think the people suggesting GP are thinking she’ll just go in and say “my husband isn’t doing it for me any more” . I think it’s more along the lines of suggesting HRT or potentially some blood tests to make sure that she’s not low on anything that might help. One of the most distressing signs that my B12 was low was when I stopped being able to orgasm. Thyroid problems can also affect libido and sensitivity so worth checking that too.

@Bookridden

Interested that some people advise the OP to discuss with her GP. I can't imagine for a second that they would be interested, helpful or even willing to listen to people talking about unsatisfactory sex. People with suspected cancer can barely get an appt.

I’ve been referred by my GP and had further investigation twice in the last 2 years on the 2 week pathway for suspected cancer.

If you have symptoms that might indicate cancer eg breast lump or unexplained bleeding post menopause that’s not due to just starting or changing HRT your GP should discuss/examine and if need be should refer you. If you feel you’re not getting this care contact the Practice Manager.

@RoyKentsChestHair

Did the B12 thing coincide with menopause? My brother has some terrible problems with B12 deficiency/pernicious anemia, but I've never considered it with regard to any women's issues before.

Are you alright now? Thanks for your post.

No the B12 thing happened about 15 years ago, so mid 30s, having also had thyroid issues for 20+ years. My mum also had thyroid and B12 deficiency which did start around menopause for her.

It’s worth checking as a possibility either way, as you’ll know it can cause irreversible damage if not treated promptly.

And thank you, not too bad these days as long as I remember to take all my various medications!

Are you all saying that you require an orgasm EVERY TIME you have sex???? I certainly don't and ive got a pretty high sex drive

Yes. And usually not singular. I very much hope this won't change through menopause, but I don't know yet.

Interested that some people advise the OP to discuss with her GP. I can't imagine for a second that they would be interested, helpful or even willing to listen to people talking about unsatisfactory sex

My doctor took me seriously, and referred me to the menopause clinic. I feared my doctor would be as dismissive as this post, but not at all, they referred me to the menopause clinic straight away. Are you really saying that the NHS is only there for stuff like cancer?

@Watchkeys

Sorry you thread has been so derailed and by some posters proclaiming how orgasmic they are and perhaps insinuating the sex is crap. I would second the posters who have given helpful advice about topical oestrogen and HRT. I also recommend a Doxy wand (the plug in one) and other sex toys to help. She may need to experiment on her own first but you would be surprised what they can drag out! It's definitely a thing - there are loads of articles about it and studies. Even for slim women who exercise. Childbirth can cause initial damage for some women and then as the pelvic floor loses tone as they age and the hormones change, things can get much harder.

And finally a Kegel8 machine to work the pelvic floor.

I couldn't imagine having sex and not orgasming in my 20's and 30's - I even remember arguing that men wouldn't have sex and not orgasm so why would women. Now I'm in my late 40's and feel differently, sometimes I like having sex, it all feels really nice, but can't be bothered to put in the concentration needed to orgasm myself.

Nick's wife is in her sixties and if he doesn't have the right to tell what he assumed was another man about his experience with his wife, then 20/30 year old's don't have the right to tell his 60 year old wife what she should be feeling (or telling him that he doesn't understand his wife or that there's something wrong with him in bed).

In your 20's and 30's you have no idea what impact aging and the menopause will have on you and your sex life.

@nolongerstill

Why is your partner not posting about this? Does she regard this as a problem? Because if the issue is that she has lost her libido and is not really interested in regaining it, then that is a separate issue you have in your relationship.

Tbf not all women go on Mumsnet! You're in danger of creating a backstory that might not even be there!

@Isitsixoclockalready

Yes, that back story is purely the creation of the poster, and I find the assumption that 'Surely if you had a problem, you'd post on MN??' to be an odd one. She doesn't use MN. I do. So why would we both post if we're talking about the same issue, as a couple? That's like both popping out to buy milk or something.

@Darhon

Thank you. We'll look into the Doxy wand you mentioned.

There has been a bit of this perhaps insinuating the sex is crap on the thread, and suspicions about my motivation/ego. It's interesting what people read into things.

Good suggestion from Doxy on the wand. Another that helps some women is the Lelo Sona 2 which is a clitoral stimulator and helps promote blood flow without actually touching the clitoris - this link explains more - www.jodivine.com/products/lelo-sona-2

Re pelvic floor, yes look at this too. Just to confuse things some women can get an overly tight pelvic floor in menopause which can also cause problems. Pelvic floor physios can help.

Just adding this review article for the giggles in case anyone hasn’t seen it metro.co.uk/2019/07/01/vibrator-funniest-review-amazon-10095225/

Sorry, Darhon not Doxy

Sexual dysfunction and inability to orgasm can be a sign of neurological disease.

Does she have any issues with passing urine?

Or any issues with her walking or speech changing?

@angeltattoo

No, nothing like that, she's fit as a fiddle! Thanks for the ideas though.

@over50andfab

I cried laughing reading that review, it's the bit about the goat-legs

That is good!

@Anothernick

Don't assume she sees it in the same way as you. To us men the of satisfying sex without an orgasm is a contradiction in terms. But women don't necessarily see it that way, my DW orgasms perhaps 40-50% of the time but often pronounces herself satisfied without one. I wondered at first if she was just saying that to make me feel good but over the years (we are early 60s) I have come to the view that she is genuine and does not see an orgasm as essential every time we DTD.

🤔 Umm! I would think she is being realistic, in that it doesn't happen every time for her, not that she wouldn't prefer it to happen every single time. As someone who reaches orgasm every time I can't imagine ever thinking that it's preferable without, but then I wouldn't wish to speak for every woman out there.

Has she had a smear test recently @Watchkeys ?
They've been known to damage nerves on occasion.