Is my female sexual response changing due to perimenopause?

Dear Dr. Milrod:

I am nowhere near menopause, but my physician says I might start experiencing symptoms anywhere from 10-15 years before onset. One of these symptoms I understand can be decreased sensitivity, making it harder to climax. I have noticed that it’s a shade harder to climax now than before. I don’t really have a decrease in my drive, but I wonder if I am as sensitive down there as before. I seem to need more foreplay and sometimes I just don’t know what’s going to work. This is actually a plus, as I am discovering a lot about sex I didn’t know before, and I am getting somewhat better about knowing my body and asking for what I need. My dilemma is that it seems pretty important to my partner that I orgasm. Is that a male thing? It seems that the pressure “to come” does not really help things. I don’t understand why sometimes I can come a lot, and sometimes not at all but it still feels good. I am not sure how to explain that it can feel very wonderful to make love for an hour and feel very close but I don’t have a full orgasm. That can be more satisfying for me emotionally and physically, than three minutes alone with a vibrator that gets me to climax very quickly. I wonder if some of the OTC topical ointments really work. What do you say when asked,”did you come?” Sometimes, I have to say “no, but it felt great.” And then you see that letdown expression?

Maria Teresa

Dear Maria Teresa:

I can understand the confusion! Perimenopause symptoms are not always about localized decreased sensitivity; in fact, one of the symptoms may be increased sensitivity to the point of being painful, because your vaginal tissues will feel “dried out” from a decrease in estrogen.

But what you are doing, and which is entirely normal from a female adult developmental view, is that you are expanding your sexual repertoire. You are getting to know your body; in fact, you are becoming a connoisseur of what turns you on, and what doesn’t. An example from a clinical case: I had a woman in her 20s who absolutely hated anyone going down on her. In the rare event it did happen, she told me she started “counting numbers in the head.” Fast-forward 10 years, and the same woman is now enjoying getting oral. Several things happened: she was able to relax into it when she felt safe and stop counting numbers in her head; also, she spent time with more mature men who didn’t treat her clitoris like a piece of hard candy – and, she got to know her body and felt more comfortable with it as she matured.

Now as to the whole “coming” issue: who is to say that an orgasm has to be one way or another? Yes, it’s important for men to feel validated in bed, but remember that men can mostly proceed from their own biological standpoint, which is an orgasm emanating largely from one focal point. For females, orgasm can range from an intense G-spot experience, complete with gushing, to an all over warm feeling that doesn’t necessarily involve the clitoris at all. As to your answer when someone asks – leave it up to the moment to respond.

In some way, I believe older, more mature men can relate to this issue as well. It seems that they are also capable of reaching all-over orgasms, some of them even “dry.” They report that same “warm all-over” sensation and release, without ejaculating. Yes, the body does change. As we get older, the focus moves away from the destination and becomes more about the journey – and a wonderful journey it can be.

Christine Milrod, Ph.D.

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