The document discusses the effects of menopause on sexuality, highlighting that many Asian women experience less severe menopausal symptoms compared to Western counterparts. It also outlines various challenges related to sexual functioning during and after menopause and offers strategies for enhancement and improvement. Additionally, the document provides resources, professional organizations, and various products to support women's sexual health and wellbeing post-menopause.

1. SEXUALITY BEYOND
MENOPAUSE
Malaysian International Conference on
Menopause
6-7th July 2019
Le Meridien Putrajaya

2. Dr. Martha Tara
Lee • Doctorate in Human
Sexuality
• Masters in Counselling
• Masters in Public Policy
and Management
• Bachelor of Arts (Comm)
• Cert in Sex Therapy
• Cert in Practical
Counselling
• Cert in Life Coaching
Relationship Counselor & Clinical
Sexologist

3. AGENDA
• Sex and Aging
• Female sexual
difficulties
• What can be done
• Sexual enhancement

4. It is commonly believed that Asian
have lower prevalence of menopausal
symptoms than Western women.
A population-based study based in Singapore on 1000 women aged 45 to 60
years noted that overall just 7% of the women were significantly bothered by
any of the symptoms of menopause.
Asian menopausal women
demonstrate a prevalence of significant
hot flushes from 10 to 30%.
64 percent of Asian women did not feel
that their reduced sexual desire lowered
their self-confidence.
90% of Asian women accepted it is
a natural consequence of getting
old.
Sohail, S., (2014). Menopause and the Asian Woman. The Journal of
South Asian Federation of Menopause Societies, 2, 23-25.
doi:10.5005/jp-journals-10032-1028

5. 8 THINGS NO ONE EVER TOLD YOU
ABOUT MENOPAUSE
1. Your workouts might change.
2. Your sex drive won't necessarily suck
3. Youcan still get pregnant
4. You may be more susceptible to STDs
5. Your hair could be thinner
6. Your sleep might suffer
7. You could feel achy
8. You may not experience any side effects
8 Things No One Ever Told You About Menopause. (2015, July 28). Retrieved from https://www.redbookmag.com/body/health-

6. Some post-menopausal
women report an increase in
sexual satisfaction.
This may be due to
decreased anxiety associated
with a fear of pregnancy.
In addition, many post-
menopausal women often
have fewer child-rearing
responsibilities, allowing
them to relax and enjoy
intimacy with their partners.
Sex & Menopause: Side Effects & Treatment | Cleveland Clinic. (2019 June 23) Retrieved from
https://my.clevelandclinic.org/health/articles/10083-menopause--sex/ (accessed 15 July 2018)

7. 7 REASONS WHY SEX GETS
BETTER AS YOU GET OLDER
1. Know what you want
2. Less afraid to leave the light
on
3. Learn how to receive better
4. Become more playful
5. Won’t tolerate what doesn’t
feel good
6. Less fixated on sex tips
7. Realise that you’re actually
pretty good
7 Reasons Why Sex Gets Better As You Get Older. (2018, June 28).
Retrieved from http://www.cleo.com.sg/guys/sex/sex-gets-better-as-you-get-
older/

8. HOW
DOES
AGING
IMPACT
SEX
LIFE?
For both men and women, the libido changes
around age 50
MEN WOMAN
Intercourse can be
different for a number of
reasons, as they may
begin to experience
erectile dysfunction or
health complications such
as high blood pressure,
diabetes, heart disease,
and obesity, which all can
impair erections.
Premature ejaculation
also becomes an issue
and is usually linked to
anxious thoughts
associated with sexual
performance.
The vagina naturally becomes
less lubricated, which can cause
pain during sexual intercourse,
so some women may want or
need to use lubricant.
The female DHEA/ testosterone
level decreases, resulting in a
lower libido.
Another change women should
take into account is the pH value
within the vagina. This often
shifts and can lead to vaginitis,
which is the change of the
normal balance of vaginal
bacteria.
Murdock, N. (2019, June 10). 9
Questions You Need to Ask
Your Doctor in Your 50s.
Retrieved from
https://aaptiv.com/magazine/
questions-health-in-your-50s

9. c
Testosterone or estrogen hormonal
imbalance.
A health check is in order.
• Vaginal lubrication decreasing
• Fewer orgasmic contractions
• Labia losing some of their
firmness
• Vaginal walls being less elastic
• Clitoris becoming highly sensitive
• Breasts drooping or sagging
SEX AND AGING FOR
FEMALES

10. 1. Urinary incontinence, or
lack of bladder control
2. Fecal incontinence, or lack
of bowel control
3. Pelvic organ prolapse, a
condition in which the uterus,
bladder and bowel may
"drop" onto the vagina and
cause a bulge through the
vaginal canal
TYPES OF PELVIC
FLOOR DISORDERS

11. c

12. cc
* No vested interest in showcasing this product and also this feature is not endorsement of this product
Vibrance Pelvic Trainer
https://vibrance.com.my/vibrance

13. c
Radical
Hysterectomy
Damage to the innervation of the pelvic floor musculature
Shortness of the vagina
Decrease lubrication
Oophorectomy Dyspareunia
Decrease in desire???
Pelvic
Radiotheraphy
Chemotherapy
Vulvectomy
Decrease lubrication
Dyspareunia
Fibrosis and stenosis
Tiredness
Nausea, vomiting
Depression
Anatomic anomalies

14. What Can Be Done

15. c
SEXUAL FUNCTIONING CONCERNS
AND HOW TO FIND HELP
• Women often find
themselves distracted
during sex by negative
images and thoughts
• Try focusing on
pleasurable feelings in
your body or on a sexy
thought or fantasy.
• Support from mental health
professional who can help
you change negative feeling
and thinking patterns
Negative thoughts
and feelings during
sex

16. c
SEXUAL FUNCTIONING CONCERNS
AND HOW TO FIND HELP
• Talk with a gynecologist
• Over-the-counter vaginal
moisturizers for before and
during sexual activity.
• You also may benefit from
learning to control the muscles
around the vaginal entrance.
• Some women can benefit from
low-dose vaginal estrogen in a
cream, tablet or ring form.
Vaginal dryness and
tightness, making sexual
activity uncomfortable or
painful

17. cc
* No vested interest in showcasing this product and also this feature is not endorsement of this product

18. cc
* No vested interest in showcasing this product and also this feature is not endorsement of this product

19. c
SEXUAL FUNCTIONING CONCERNS
AND HOW TO FIND HELP
• Ask your health care team to
check your medications.
Antidepressants or anti-anxiety
medicines may make it more
difficult for you to have an
orgasm.
• Give yourself time. Try not to
pressure yourself to have an
orgasm. Try to have a goal of
enjoying sex and getting as much
pleasure as possible. The nerves
that help a woman feel pleasure
around the clitoris and in the
vagina are rarely damaged by
cancer treatment.
Difficulty feeling
pleasure during
sex

20. c
SEXUAL FUNCTIONING CONCERNS
AND HOW TO FIND HELP
• If you have lost feeling in an
area of your body that gave
sexual pleasure you may
need to find new caresses
that you enjoy.
• Communicate with your
partner.
• Ask for a referral to a sex
therapist who specializes in
treating cancer survivors.
Difficulty feeling
pleasure during
sex

21. SEXUAL FUNCTION ASSESMENT
TOOLS FOR CLINICIANS
1. Relationship Assessment Scale https://goo.gl/fJhFmH
2. Female Sexual Function Index https://goo.gl/vgf7Wv
3. Female Sexual Distress Score – Revised https://goo.gl/jWqqY2
4. PISQ-12 - New Patient Pelvic Organ Prolapse/Urinary Incontinence
Sexual Function Questionnaire https://goo.gl/DZ3s5N
5. PISQ-31 - A New Instrument to Measure Sexual Function in Women with
Urinary Incontinence or Pelvic Organ Prolapse https://goo.gl/2VrkRC

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1. Moisturizing the
skin of vulva and
vagina
2. Massaging your
vulva
3. Internal massage
VAGINAL RENEWAL

23. Source: https://sexualityresources.com/sites/default/files/documents/VR%20pamphlet%2017.pdf

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Stage 1
• Without genital touch
Stage 2
• With genital touch
Stage 3
• Go with the flow
SENSATE FOCUS

25. 4 TYPES OF SEX
1. Procreation
2. Recreation
3. Restoration
4. Transformation

26. 1. KEGELS – These are little squeezes of your
pubococcygeus muscle.
2. BREATH – Sexual energy travels on the breath. The
more you breathe, the more you feel.
3. TOUCH – There is a fine line between too much pressure
and too little.
4. SOUND – Move erotic energy throughout your body with
sound.
5. MOVEMENT – Movement in any part of your body
focuses and releases energy from that part.
6. INTENTION – Where intention is, energy flows.
7. FANTASY – Give your mind erotically constructive things
to do.
Lee, M.T., (2015) Orgasmic Yoga: Masturbation, Meditation and Everything In-Between. Scotts Valley, CA: CreateSpace.
7 TOOLS FOR MORE ECSTATIC STATES

27. c
1. Moisturize and massage your
genital tissues.
2. Maintain pelvic floor strength.
3. Take sexual ownership.
4. Regularly schedule orgasms.
5. Make more time for sex.
6. Expand the ways of having
sex.
7. Get professional help
MORE
TIPS
FOR
WOMEN

28. Sexual Enhancement

29. SEX FURNITURE
• It’s any piece of furniture that aids in a sexual experience.
• This can be for added excitement, making certain positions
easier, or for those with handicaps or injuries.
• Sex furniture can be anything from a simple foam triangle to an
elaborate contraption that looks like it should be in a dungeon.
Sex Furniture 101 - A Detailed Guide and Candid Product Reviews. (2019 June 24). Retrieved from https://www.lovense.com/sex-furniture

30. cc
* No vested interest in showcasing this product and also this feature is not endorsement of this product

31. MHP TONGUE JOY
• Excellent little massager
that attaches to tongue or
any body part with one of
the elastic silicone bands
provided
• Has wired hand-held
control to increase intensity
and speed of vibration
FLESHLIGHT
• Realistic penetration device
• Easy to grip with one or two
hands
• No batteries or plug-in
required
• Lightweight

32. cc
* No vested interest in showcasing this product and also this feature is not endorsement of this product

33. cc
The O-WAND has won two Red Dot Awards in the
‘Sex Toy’ and ‘Massage Device’ categories.
O-WAND Free Attachment | Cordless Vibrator | O-WAND®. Retrieved from https://www.o-
wand.com/product/detail/o-wand-free-attachment.html (accessed 21 July 2018)
* No vested interest in showcasing this product and also this feature is not endorsement of this product

34. cc
* No vested interest in showcasing this product and also this feature is not endorsement of this product

35. cc
* No vested interest in showcasing this product and also this feature is not endorsement of this product

36. cc
Ben-Wa Balls Jade Stone
* No vested interest in showcasing this product and also this feature is not endorsement of this product

37. VIBRO-STIMULATION
DEVICES
• Powerful vibrator
• Large handles and easy to
grip
• Oversized soft control
buttons can easily be pushed
• Medical-grade material
reducing the risk of skin
irritation by latex devices
• Rechargeable batteries

38. FOCUS ON SHOWING
YOUR FEELING FOR ONE
ANOTHER IN OTHER
WAYS BY:
1.Enjoying being close to
each other
2.Touching and stroking
3.Kissing
4.Massaging
5.Talking
6.Holding hands

39. WHAT CAN WE
DO?
Own our sexuality
• Talk - Be Open
• Ask – Professionals
• Learn: Read, explore
sexual aids etc.
• Communicate

40. PROFESSIONAL ORGANIZATIONS
1. AASECT - American Association of Sexuality Educators, Counselors
& Therapists https://www.aasect.org/
2. SSSS - Society for the Scientific Study of Sexuality
www.sexscience.org
3. SSTAR - Society for Sex Therapy & Research https://sstarnet.org/
4. Kinsey Institute https://kinseyinstitute.org/
5. WPATH - World Professional Association for Transgender Health
https://www.wpath.org/
6. IPSA - International Professional Surrogates Association
http://www.SurrogateTherapy.org
7. ACSB - Association of Certified Sexological Bodyworkers
https://sexologicalbodyworkers.org/
8. Source School of Tantra Yoga http://sourcetantra.com/

41. Download at
Disabilities Health Research
Network
http://www.dhrn.ca/files/sexualhe
althmanual_lowres_2010_0208.
pdf

42. RESOURCES:
1. Disabilities Health Research Network http://www.dhrn.ca/
2. Kenneth Ray Stubbs www.sexualshaman.com
3. Dr Mitchell Steven Tepper www.mitchelltepper.com (incomplete C6-7)
4. Cory Silverberg http://corysilverberg.com/
5. Facts and Figures at a Glance. (2019 June 23) . Retrieved from
https://www.nscisc.uab.edu/
6. Sex and Paralysis Video Series created by Dr Mitchell Steven Tepper
http://www.drmitchelltepper.com/sex_and_paralysis_video_series
7. Sex Furniture 101 - A Detailed Guide and Candid Product Reviews.
(2019 June 24). Retrieved from https://www.lovense.com/sex-furniture
8. Jain NB, Ayers GD, Peterson EN, et al. Traumatic spinal cord injury in
the United States, 1993-2012. JAMA. 2015
9. Lasfargues JE, Custis D, Morrone F, Carswell J, Nguyen T. A model for
estimating spinal cord injury prevalence in the United States.
Paraplegia. 1995;33(2):62-68

43. References
1. Report on global sexually transmitted infection surveillance 2015. Retrieved from
http://www.who.int/reproductivehealth/publications/rtis/stis-surveillance-2015/en/ / (accessed 15 July
2018)
2. Sex & Menopause: Side Effects & Treatment | Cleveland Clinic. Retrieved from
https://my.clevelandclinic.org/health/articles/10083-menopause--sex/ (accessed 15 July 2018)
3. Sohail, S., (2014). Menopause and the Asian Woman. The Journal of South Asian Federation of
Menopause Societies, 2, 23-25. doi:10.5005/jp-journals-10032-1028
4. Murdock, N. (2019, June 10). 9 Questions You Need to Ask Your Doctor in Your 50s. Retrieved from
https://aaptiv.com/magazine/questions-health-in-your-50s
5. O-WAND Free Attachment | Cordless Vibrator | O-WAND®. Retrieved from https://www.o-
wand.com/product/detail/o-wand-free-attachment.html (accessed 21 July 2018)
6. Lee, M.T., (2015) Orgasmic Yoga: Masturbation, Meditation and Everything In-Between. Scotts Valley,
CA: CreateSpace.
7. Top Myths About Sex. (2011, March 23). Retrieved from https://blog.draroras.com/top-myths-about-sex/
8. 7 Reasons Why Sex Gets Better As You Get Older. (2018, June 28). Retrieved from
http://www.cleo.com.sg/guys/sex/sex-gets-better-as-you-get-older/
9. 8 Things No One Ever Told You About Menopause. (2015, July 28). Retrieved from
https://www.redbookmag.com/body/health-fitness/a38472/menopause-side-effects/

44. Dr. Martha Tara Lee,
D.H.S.
Relationship Counselor & Clinical Sexologist
Eros Coaching Pte Ltd
Website: www.ErosCoaching.com
Email: drmarthalee@eroscoaching.com