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Sex and the Menopause

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We speak to psychosexual & relationships therapist Kate Moyle.

Could you begin by telling us a little bit about yourself and what you do? What exactly is psychosexual therapy?

I work as a psychosexual & relationships therapist in Central London and also co-founded a therapy practice called The Thought House Partnership which provides a range of psychological therapies under one roof.

As a psychosexual & relationship therapist, I offer couples and individuals, talking therapy that is focused around sexuality difficulties. However these issues may present, and however they are impacting people’s lives and relationships, therapy holds a space for this to be talked about and hopefully worked through. In general, sex is still considered a taboo subject and often comes attached to feelings of embarrassment or shame which makes it even more important that there is a safe space to discuss sex and the challenges that may be associated with it.

Many women experience a ‘loss of libido’ during the menopause – how does one begin to tackle this lack of sex drive? What can cause it?

What we understand is that there are two different but connected processes at play when it comes to sex. The first is arousal which is the physical process your body goes through to be ready to have sex and the second is desire which determines whether a person wants to have sex or be sexual. If sex is painful, for example due to vaginal atrophy (dryness) which is a common symptom experienced during the menopause process, then we are not going to feel encouraged to want to have sex again. It makes no sense for us to desire something that we feel anxious about or that causes us pain, in the same way that when something feels good we want to go back for more. So, we can understand that this may be one factor that is impacting women, along with hormonal and bodily changes. Another important aspect to consider is how we feel about ourselves psychologically when going through the menopause as this can play a role in sex drive. It is also important to not just think about the physicality of the symptoms but also what they mean to the person experiencing them as the psychology of what is happening is very important.

We understand that the idea of sex drive is multi-dimensional. There is more going on than spontaneous arousal. Female sexual desire in particular is what we describe as responsive. Dr Rosemary Basson in 2001 really introduced the idea that there are multiple factors at play that help to get us in the mood for being sexual and that rather than desire, or wanting to have sex being something that just spontaneously occurs, we respond to stimulation whether it be physical, emotional or psychological.

With this in mind, if these are the feelings that are being experienced by someone the best way to work on your sex life is by being creative in the ways that you are sexual. Foreplay is an essential part of the arousal process, but it’s also important to consider other aspects of sex that are non-penetrative and can be enjoyed. The clitoris is the primary sexual and pleasure organ for women and clitoral stimulation can be enhanced using lubricanst to add a different element. It’s also important to play with sensations such as touch, massage, kissing and also stimulating the mind for example reading, listening to or watching erotica. If intercourse has become a source of pressure and anxiety then that will overshadow the positive relationship that you had with it before; so if you feel able to, step away from it temporarily and try something different.

What is the biggest difficulty that women face in their sex life?

There are a huge range of difficulties that both men and women face when it comes to sex, and they are as completely unique as that individual. One of the biggest difficulties that it feels women are facing is feeling that they don’t know what they as an individual like when it comes to sex. Sex is largely about fun, and pleasure but these conversations are only truly starting to come into the mainstream now. Education about sex for pleasure and fun’s sake is becoming recognised as a primary sexual factor, particularly for women now but women should still go through a process of their own sexual education. Listening to talks or podcasts, exploring and getting to know their bodies. If you feel more comfortable in your own body and what you like, it will only put you in a better place to communicate that to a partner.

How can loss of libido affect a relationship? Is this an irrational fear or something that partners really need to talk about?

The biggest difficulties in relationships happen not from loss of libido but where there is a mismatch of libidos between partners and one is left wanting more and the other less. This aside from the physical loss of pleasure and closeness can leave one, or both partners feeling rejected and bring up negative emotional feelings. Communicating about how you are both feeling is key to overcoming irrational thoughts or fears about what might be going on. We are all guilty of thinking that we know what is going on in our partners’ head even though we clearly can’t know. So, it’s important to check. Feelings of shame, and embarrassment are real barriers to intimacy and this is where changes in our sex lives can clash with our intimate relationships.

Is it ‘wrong’ or harmful to push yourself to have sex with your partner to keep them happy even if you don’t want to? What are some ways of handling that pressure to please?

Communicate, communicate, communicate! It’s really important to explain to your partner about how you are feeling. A sex life that causes you discomfort and leaves you with a sense of never wanting to do it again, is not going to helpful for you as an individual, or your relationship. It might feel challenging to open up the conversation, but it’s important to talk about it. There are many reasons that people have sex: pleasure, fun, love, connection, intimacy, attraction, emotional closeness, wanting an orgasm, and the list goes on. If you are in an intimate relationship, many of those feelings can be equally achieved in ways other than intercourse but you just need to explore that together. It’s not the physical aspect of sex necessarily that people miss, it’s the psychological and meaning component. There are also a huge range of sex toys for both men and women that can help couples to experience non-penetrative pleasure together without taking away from intimacy.

How can low self-esteem affect sex life?

Self-esteem of course impacts our sex lives. When we are feeling good, we feel more confident, better and more secure about ourselves. This means that we are better prepared for going into a vulnerable space which is exactly what sex is. Sex is exposing both physically and emotionally and so when we are feeling fragile that can shake us and we can get very stuck in our heads which ultimately means we aren’t fully in our bodies and fully physically experiencing.

To learn more about Kate Moyle’s work, visit

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Meg's Quote

If you are depressed,
you are living in the past.
If you are anxious,
you are living in the future.
If you are at peace,
you are living in the present.
– Lao Tzu –

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