The dilemma I am a 52-year-old woman who has had a difficult perimenopause. I have read extensively on the subject and tried various supplements to ease this transition. My experience has included hot flushes, night sweats, depression, anxiety, insomnia and heavy periods. I was suffering the most debilitating anxiety to the point where I could barely function. I am on bio-identical HRT (Oestragel and Utrogestan), but these had little effect in easing the symptoms. I had no choice but to take antidepressants even though my symptoms were due to hormone fluctuations.
As a side effect my libido fell drastically (a healthy sex life had been maintained until this point and I have always found it easy to orgasm). What I did not expect was that my clitoris physically shrunk and orgasms become almost impossible to achieve.
I have been off the antidepressants since the end of August as I did not like how I was feeling and the lack of sensation and orgasms. My clitoris has not grown back and I have not regained any real sensation that is comparable to my previous experience. I am largely feeling numb. I am devastated by the thought of living as a female eunuch. I also do not feel comfortable discussing this with my GP.
Mariella replies I’m so glad you wrote. Opining about a wide variety of issues, many of which I have scant knowledge of is, I’m afraid, the lot of any agony aunt and I have no medical qualifications whatsoever, so proper medical advice is not something I can offer – but I do know a little about the menopause.
Clitoral atrophy is a thing: a condition that a small minority of women suffer from which is brought on by a use-it-or-lose-it scenario during perimenopause. It’s one of the many mysteries of the menopause that the world fails to educate us on until we’re already in the danger zone. It’s not only worth a trip to the GP, but is nothing to be ashamed of, and is usually quite easily cured with a little lubricant and some tender care.
It’s a source of continual frustration that a liminal phase of every women’s life, when a variety of ailments afflict us due to a huge drop in hormone levels, should still be a topic of shame. So, I repeat that what you really, need is a good GP to tell you that everything is as it should be and, possibly, to offer further treatment.
I may be ill-equipped to answer you on a medical basis, but I do know that one of the side-effects of antidepressants is a loss of sensitivity in your clitoris and with that comes an inability to orgasm. It’s actually a common reason why people give up on antidepressants if their symptoms aren’t too onerous – not wanting to lose the one bit of unbridled emotional and physical release they can access deep in the fog of low mood.
So far so normal in your case, is what I’m saying. Since the clitoris swells during stimulation, the fact that it might diminish in periods of sexual famine also stands to reason, so inactivity has probably contributed to the sense you have that it has shrunk. There’s only one way to find out, of course, and that’s to get back in the habit.
Losing your libido is simply a symptom, not a life sentence, and one that you can tackle in any number of ways, from replenishing hormone levels to embracing mood-enhancing moments in your day where a sense of the erotic might have a chance to flourish.
One of the many issues with menopause is how we end up struggling with conditions and symptoms that we neither recognise or are prepared for. They come at you from different directions, often all at once, and it can be incredibly traumatic. You sound like you’ve suffered a veritable storm of all the most debilitating intrusions, but I can reassure you that this is, thankfully, just a passing phase in our fertility cycle. Rather than do some vacuous diagnosing here, though, I’d urge you to return to the doctor who put you on HRT and ask about other helpful supplements, such as testosterone (research has shown that women suffer from testosterone depletion during the menopause). It could be key to returning your libido and lifting your energy levels. It sounds to me as if you’ve been floored by what can be a truly debilitating period that all women have to navigate, but for which there is outrageously little support or understanding.
Ultimately, this transition, painful though it can be, makes way for a new, liberated and enriching time of life – post-periods and baby-making. You haven’t yet reached those tranquil shores when all seems possible again and life as you’ve known it resumes, often for the better.
Getting the right support medically, sharing your frustrations with your partner and friends and generally being loud and proud on your genetically programmed turbulence is the route to a better experience and a return to a sense of who you are, not just who you’ve been reduced to during this period of turmoil.
If you have a dilemma, send a brief email to mariella.frostrup@observer.co.uk. Follow her on Twitter @mariellaf1
