Along with hot flashes and sandpaper sex, add the sudden inability to have an orgasm to the list of postmenopausal surprises your mother “forgot” to warn you about. But if you are one of the many women whose fireworks have turned into barely a flicker, I have good news for you — really good news. A functional penis, intercourse and estrogen are unnecessary requirements when it comes to the path to achieving orgasm.
This should be a huge relief to millions of postmenopausal women who are wondering if they will ever have an orgasm again. Don’t get me wrong, estrogen helps, but it is not required. Plenty of women have orgasms without a drop of estrogen in their body. What is required for that “happy ending” is a healthy clitoris that responds to stimulation. Decreased blood flow because of aging, low estrogen and damage to blood vessels from other medical problems — such as diabetes, cancer treatments, multiple sclerosis or vascular disease — all sabotage the ability of nerve endings to respond. Those tiny clitoral nerves require adequate blood to function properly.
The solution is to wake up those nerve endings, which can be accomplished using one — or all — of the following strategies.
Increase clitoral blood flow
While estrogen isn’t required, a little estrogen can make a big difference.
Local vaginal estrogen increases blood flow not only to vaginal and vulvar tissue, but also to the clitoris. I advise women who are having difficulty with orgasm to routinely apply a dot of estrogen cream directly to the clitoris.
Arginine, aminophylline, testosterone or other vasodilators can be compounded into a cream that can be applied directly to the clitoris. While not well studied, anecdotally these products seem to increase sensitivity. Your gynecologist may not be familiar with these creams — so you may need to seek out a menopause sexual medicine expert to get a prescription.
Drugs that are intended for arousal, libido or vaginal lubrication such as systemic estrogen, testosterone, flibanserin, bremelanotide and DHEA are primarily intended for other purposes, but along the way may dramatically facilitate the ability to have an orgasm.
CBD and other cannabinoids have not been tested, other than in bedrooms around the country, but cannabinoids are vasodilators so it stands to reason that they may be beneficial. I tell my patients to apply some CBD oil directly to the clitoris around 30 minutes prior to sexual stimulation. Don’t forget to slowly rub it in! I have gotten rave reviews, though there are no scientific studies yet that specifically look at effects of CBD applied to clitoris. This falls into the category of “try it to see if you like it.”
Pelvic floor physical therapy
There is evidence that pelvic floor physical therapy not only enhances the ability to have a satisfying pelvic floor contraction during orgasm, but also facilitates the ability of the clitoris to respond by increasing blood flow to the genitals.
Increase stimulation
Makes sense, right? If nerve endings are not as responsive as they used to be, you just may need to stimulate them more. If you were always able to have an orgasm with clitoral pressure, oral or manual stimulation, those maneuvers may no longer be exciting enough for nerve endings that are tired, older or damaged. Your battery-operated boyfriend or girlfriend is reliable, always good to go and — most important — almost always triggers an orgasm. It is critical that your vibrator of choice gives you clitoral stimulation. If you already use a vibrator to climax but are reluctant to use one during partnered sexual activity, I promise that most partners want to give you pleasure and will be happy to accommodate a toy to help the process. There are many vibrators that are intended to be used during partner sexual activities and can also be used during intercourse.
What about Viagra?
It’s so tempting … his little blue pills are sitting there, just waiting for you. Viagra and other phosphodiesterase type 5 inhibitors such as daily Cialis have been shown to increase genital blood flow in men. But they are not approved by the Food and Drug Administration and have not been widely tested in women. Having said that, there is data to suggest that these drugs can be effective in some women and are particularly helpful in women who have difficulty having an orgasm because of their antidepressant, diabetes or multiple sclerosis.
The important thing is if your orgasm is history, you do not have to give up. There are solutions.
For more on how older women can enjoy a satisfying sex life, go here.
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