I'm 63 & have been celibate for years. How do I start having sex again?

Q. I'm a 63-year-old woman who has not had sex in many years. Can you give me some advice so I can start again?

A. It is possible to resume sexual activity after a long time of celibacy. For some people, the decision may have been a simple one with little external influence, or a partner may have passed on or perhaps may have been recovering from or managing a chronic illness.

The reasons are varied and depending on the issues you may require a therapist or sexologist for holistic support and resolutions of emotional or psychological issues. It is important to understand previous patterns of sexual activity and previous relationship or emotional contexts of sexual behaviour. 

Post menopause, when oestrogen levels are low, the vaginal lining becomes thinner, which means it can take longer for the vagina to swell and lubricate during sexual arousal leading to discomfort and painful sexual penetration.

It is advised to engage in self-play, masturbation, to start easing back into sex; erotic and genital massage and reciting positive affirmations throughout self-play without the use of penetrative sex (until you feel comfortable) are great.

Foreplay with a partner also helps stimulate natural lubrication and helps set the mood. Foreplay can be long and, for a few times with a partner, you may only be comfortable up to this stage.

Activities such as talking, touching and kissing can help promote intimacy and lead to sexual satisfaction.

You may enjoy different sex positions from the last time you had sex. It is good to try new positions to find what feels best. In some, the vaginal canal may become smaller and a dilator, which is a smooth tube, can be used to gently stretch your vaginal tissues.

Over-the-counter lubricants are encouraged and if penetration remains painful, ask your doctor about treatment options such as vaginal oestrogen, especially if you are post menopause. It is always advisable to consult your doctor for an annual check-up and screening.

There's no age limit for sexually transmitted infections, so use a condom every time you have sex.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za.

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