Sexual Wellbeing in Menopause: Cultivating Healthy Sexual Relationships

Sexual wellbeing integrates sexuality into your overall well-being. It encourages us to think about and make conscious choices about our own sex lives and relationships, as well as the sexual health and vitality of families and communities. During perimenopause and menopause, hormonal changes can impact the brain and body and often relationships, affecting your sexual wellbeing.

Sexual wellness is comprised of several factors, including:

• recognizing and respecting the sexual rights we all share,

• getting out of toxic relationships,

• having access to sexual health information, education, and care.

• being informed about and practicing safe sex and seeking care when needed.

Image: courtesy of Freepik

What is Sexual Wellbeing?

Sexual wellbeing is the idea of maintaining a healthy, satisfying sex life. Humans are sexual beings from birth to the grave. Sexual wellness promotes healthy relationships with sex and our bodies.

Sexual wellbeing is closely connected to and influenced by our physical, mental and social wellbeing. It includes achieving and maintaining good health, practicing safe sex and having a pleasurable and consensual sex life.

For the vast majority of human history religious and cultural values have determined rules around sex and sexuality. Who can have sex with whom, and for whom it should be pleasurable.

As healthcare systems developed in Western countries the definition of sexual health consisted of being free from sexually transmitted disease. With the advent of contraception and legal abortion, the definition expanded to include women being able to choose sexual wellness that avoided unwanted pregnancies.

Since 1974 the World Health Organization and public health departments, psychosexual clinicians and sex therapists have been attempting to understand sexual health in a more expansive and sex positive way; in terms of creating a pleasurable and safe sexual relationship to self and others.

How does the world health organization define sexual health?

The World Health Organization currently defines sexual health as:

“an integral part of overall health, well-being and quality of life.

It is a state of physical, emotional, mental and social well-being in relation to sexuality, and not merely the absence of disease, dysfunction or infirmity.

Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all people must be respected, protected and fulfilled.”

How Important is Sexual Wellness?

Sexual wellness benefits individuals, relationships and communities. Individual benefits of sexual wellness include:

1. improved mental and physical health

2. greater self-esteem, body confidence and self-acceptance

3. more satisfying sexual experiences

Benefits of sexual wellness for relationships include:

1. improved communication and emotional intimacy with partners

2. enhanced trust, respect and mutual support

3. greater connection to the larger community and shared cultural values

Societal benefit of sexual wellbeing includes:

1. reduced rates of sexual violence, harassment and abuse, including between intimate partners.

2. decreased risk of sexually transmitted infections, including HIV/AIDS

3. decreased unwanted pregnancies, unwanted children and abortions

4. increased opportunities for pleasure, intimacy and connection within our communities

5. more equitable relationships between men and women, as well as people of different races, cultures and sexual orientations

6. reduced discrimination, marginalization, and stigmatization – for example the LGQBT+ community and those living with HIV.

Overall, achieving sexual wellness is an important part of living a healthy and fulfilling life, individually, relationally and societally. By taking steps to improve our knowledge, attitudes, behaviors, and experiences around sexuality, we can create healthier relationships with ourselves and others, and help build a safer, more inclusive world for everyone.

How To Improve Your Sexual Health and Wellbeing?

Sex can look different for different people. It can be solo-sex or self-pleasure or partnered sex. The range and repertoire of sexual practices can be different as can a person’s sexual desire levels and preferences. However there are some guiding principles, that help to create a more pleasurable and safe sexual experience and relationships.

Sexual health can be understood as a integration of principles that tie together personal values, ethics, religious beliefs, cultural norms and sexual interests or practices. The following 6 principles adapted from the WHO definition of sexual health can act as a map to guide individuals as they navigate consider their own relationship to sexual wellbeing (Braun-Harvey, 2009).

Couples can use these principles to negotiate their sexual boundaries and relationship in a healthy way. Additionally families can use these principles around which to structure conversations regarding sexual activity, sexual functioning, and sexual relationships. It can be tricky for teens and young people to navigate their emerging sexuality and make choices about sex that align with their values.

Principles of Sexual Wellness and Health

1. Consent

Sexual wellbeing is denied without consent. Consent is the basis of bodily and self autonomy. Consensual sex is sex that is entered into and participated in voluntarily. Instead of viewing sex as either wanted or unwanted – a simplistic view, within a particular sexual encounter sexual boundaries are constantly negotiated and constructed (Holmström 2020).

Consent requires ongoing communication. This communication is verbal and nonverbal. It is important to remember that nonverbal cues can be misinterpreted. Additionally, someone’s ability to provide consent can be impacted by the use of drugs and alcohol.

It is important to constantly check in with your partner(s) during a sexual encounter to ensure that they are still comfortable with what is happening, and that they are enjoying themselves.

Consent can be withdrawn at anytime for any reason.

Non-consent forces children or adults into sexual experiences that they do not desire or want. Non-consent takes the form of child sexual abuse, sexual assault, and rape. It can occur between strangers, but is more commonly among aquaintances and intimate partners.

Consent transforms sexual experiences from an invasion or violation into acts of transformation, pleasure, communion, connection and so much more.

When consent is given, one is saying, “I want this experience, I want it to have an effect on me, to give me something that I desire, and I want you to participate in this with me.”

Being able to exert your own desires and navigating boundaries is a lifelong skill necessary to being able to enjoy a healthy relationship.

2. Non-Exploitive Sex

Sexual health and wellbeing requires sex to be non-exploitative. Sexual exploitation occurs when a person uses their power and control to manipulate another person for their own sexual gratification. Sexual desires do not entitle anyone to manipulate or coerce another to have sex with them.

Exploitation compromises and at times negates a persons ability to give full and free consent.

Exploitation includes unwanted harsh or cruel domination, grooming, coercion, manipulation or taking advantage of a person who is incapable of using their cognitive and emotional capacities to give or not give consent.

It renders someone incapable by exploitative processes outlined above. Using alcohol or drugs can equally render someone vulnerable to exploitation for sex.

Sexual exploitation can also occur when one partner cheats on the other partner, having sexual relationships outside of their sexual contract or understanding.

3. Honesty

A healthy sexual relationship depends on a foundation of honesty. Individuals need an honest relationship with themselves and each sexual partner. Good communication between sexual partners depends on openness and speaking truth.

Keeping secrets and telling lies create discomfort, and conflict within the self and within relationships so should be avoided to enjoy fulfilling sexual relationships.

Being open with yourself and partner about your sexual orientation and gender identity can be important for sexual wellbeing. The capacity to recognize and express feelings honestly is another key to developing a healthy relationship.

4. Shared Values in Sexual Relationships

Individuals and couples have a number of values that guide their sexual relationships. These can be multiple or single, but it is important to align your values with those of the person you are having sex with.

If one partner values casual sex or open relationships, but the other partner values friendship, kindness and loyalty this relationship is likely going to have difficulties and produce some heart-break and sexual ill-health.

Happy couples are more likely to have shared values. These could include:

1. monogamy,

2. marriage

3. open relationships,

4. abstinence,

5. fidelity,

6. open communication,

7. mutual respect.

Shared family values around sex can promote sexual health and wellbeing. Parents can help provide a framework for navigating difficult conversations about sexuality, promoting healthy sexual relationships, and fostering self-awareness and growth.

5. Protected From STI, HIV, and Unwanted Pregnancy

 

Sexual wellbeing requires safety when engaging in sexual experiences. Safe sexual experiences involves being mindful of the potential risks associated with engaging in any type of sexual activity, such as sexually transmitted infections (STIs) or unwanted pregnancy.

Practicing safe sex by using condoms or other barriers (such as dental dams for oral sex) during partnered sex, getting tested regularly for STIs, and speaking openly and honestly about your sexual history are all ways to ensure you are protected from STIs and HIV and unwanted pregnancy.

During perimenopause, even though fertility is reduced, there is still a chance of pregnancy so birth control is recommended until you have had more that a year without a period.

It is the responsibility of each individual who engages in sex to have a plan for preventing STI’s and pregnancy if at risk (i.e. heterosexual relationship).

It is also important that children, teens, and adults have access to accurate information about their bodies and sexual health so that they can make healthy decisions for themselves when engaging in sexual activity.

This includes learning about birth control options, how their body responds sexually, how to access STI testing and prevention, and how to have healthy conversations about sex with partners.

6. Pleasure

Pleasure is a primary motivation for solo-sex (masturbation) and partnered sex. It is important that teens and adults understand their body, and their capacity for pleasure and orgasm. These details are often excluded from conversations with teens around sex.

Often the focus is on safe sex or the mechanics of sex, or how babies are made, but many teens are denied information about pleasure because parental, religious or societal values judge pleasure to be irrelevant or unnecessary part of sexual education.

What is pleasurable can be different for different partners. It may take time for you to discuover what sensations and experiences your enjoy. Sensual pleasure includes many aspects from kissing, to stroking, massage, touch, to different sexual practices and different positions during sexual intercourse. Some individuals and couples use sex toys, vibrators, textured or flavored condoms and lubrication to enhance comfort and pleasure during sex.

Open and ongoing communication and lifelong learning is essential to communicate your personal likes, dislikes and preferences during each sexual experience. Remaining open to learning more about what is pleasurable to yourself and your partner can help enhance pleasure during sexual intimacy.

Some medical conditions, medications or hormonal changes such as pregnancy, breast feeding, perimenopause and menopause can reduce sexual pleasure. Getting support for conditions like vaginal dryness can be important in supporting sexual wellbeing.

Next Steps in Improving Your Sexual Wellbeing

If you are interested in improving your own sexual health, or your partners and loved ones, there are many resources available to help you achieve sexual wellbeing. Some key steps include:

1. practicing safe sex – all partners need to take responsibility for this.

2. think about and define your own sexual boundaries

3. seek support and advice from doctors or therapists who specialize in sexual wellness and relationships,

4. attend workshops or seminars on sexual health topics,

5. read books and articles on the subject.

Recommended Reading List for Sexual Wellness

There are so many good books out there but 2 excellent books to start with that particularly address sexual wellness and pleasure in women include:

1. Come As You Are: Revised and Updated: The Surprising New Science That Will Transform Your Sex Life Paperback – by Emily Nagoski

2. Becoming Cliterate: Why Orgasm Equality Matters–And How to Get It Paperback – Illustrated, by Dr. Laurie Mintz

Sexual wellbeing is important through the life-cycle, including during perimenopause and menopause.

Key Resources for Sexual Health and Intimacy

This is not a comprehensive list, but a starting point. Recommended resources are sex positive, informative, inclusive and affirming.

Books on sexual health and intimacy

S.E.X., second edition: The All-You-Need-To-Know Sexuality Guide to Get You Through Your Teens and Twenties by Heather Corinna

This book is not just for teens and young adults. Many women and men of older generations did not get a great sex education. Many also were exposed to sex negative views around sex and sexuality. Maybe you are curious about different sexual orientation or expression. You can learn more about all of these topics here.

A Celebration of Vulva Diversity – A book by The Vulva Gallery

This great book celebrates vulval diversity and makes great headway in allowing women to accept their vulva, and shed any shame they may have.

The Body is Not An Apology by Sonya Renee Taylor

Websites promoting sexual health and intimacy

thevulvagallery.com 

Women have often been shamed about their vulva – this website contains many portraits of diverse vulva shapes and sizes. It is a vulval celebration.

scarleteen.com 

This website is a sex positive education site aimed at teens but beneficial for people of all ages and orientations. It aims to be inclusive of many different sexual experiences.

I wish you well with your sexual relationships and sexual wellbeing.

References

1. Harvey Institute. https://www.theharveyinstitute.com/six-principles-of-sexual-health (accessed May 4, 2022)

2. Holmström C, Plantin L, Elmerstig E. Complexities of sexual consent: young people’s reasoning in a Swedish context. PSYCHOL SEX. 2020;(4);342-357. https://doi.org/10.1080/19419899.2020.1769163 

3. WHO. Defining Sexual Health. https://www.euro.who.int/en/health-topics/Life-stages/sexual-and-reproductive-health/news/news/2011/06/sexual-health-throughout-life/definition (accessed May 5, 2022).

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