Sexual Problems around Menopause

For women who experience changes in sexual function during the years immediately preceding and following menopause, the com­plaints they bring to the physician’s office can be divided into five categories:

1. Loss of desire

2. Decreased frequency

3. Painful intercourse

4. Diminished responsiveness

5. Dysfunctions of their male partners

Let’s consider these individually, although sometimes these problems may be cumulative for any one couple.

Loss of Desire

Desire is a complex phenomenon. The psychological factors that in­fluence it are extremely important, including the nature of your rela­tionship with your partner. If you experience a loss of desire even though there is still normal hormonal activity in your body, your problem may require deeper evaluation and, perhaps, the help of a sex counselor. At the time of menopause, however, the decline of ovarian hormones often influences the components of sexual desire and arousal. So if your diminished desire is due to a loss of sensory perception through the local and central nervous system, changes in the rate of blood flow, less tension within the muscles, and the de­creased ability of the sexual glands to lubricate the vagina, you may be relieved to know that these changes respond very well to HRT. When adequate hormone therapy is introduced, desire and arousal normally return.

Decreased Frequency of Sexual Activity

Again, many factors are at work when you experience decreased frequency of sexual activity, and the majority of them are not hor­monal. Most are related to your lifestyle and your relationship with your partner. Together, you need to sort out such issues as fatigue, interest, time, competing activities, or other tensions in the relation­ship. Do you spend as much “bed time” as television time, or is a too-active social life competing with your sex life? If sex is important equally to you both, you need to work out a mutually satisfactory frequency pattern and set aside the time, create the mood, and satisfy your own and each other’s needs whenever possible.

Painful Intercourse

The solution to this problem must include your physician, for this problem is decidedly the easiest to address and, in most instances, it is related to decreased estrogen stimulation of the vaginal canal. Ap­propriate hormonal replacement almost without exception results in the disappearance of this uncomfortable symptom.

Diminished Responsiveness

This symptom is usually resulting from a decrease in estrogen and the subsequent lack of stimulation of nerves in the pelvic and vaginal area and in the brain itself. Estrogen treatment is of benefit in most in­stances, and is highly recommended.

Dysfunction of the Male Partner

A surprising finding from research shows that older women have more interest in sex than older men. Possibly one of the biggest problems facing the aging male is his decreased ability to become aroused and, as a result, to obtain or keep an erection for long periods of time. In many cases, this problem can be satisfactorily treated through sexual counseling, which we strongly recommend. Be reas­sured that even if your male partner is unable to obtain an erection, satisfactory sexual activity can still take place if you are motivated and instructed in other means of sexual gratification.

Achieving sexual satisfaction is largely dependent on your relation­ship with your partner. You can certainly appreciate the fact that you would not be turned on sexually or able to achieve orgasm if your partner was in pain, disabled, or obviously not enjoying the sexual activity. So it may be that when a man perceives his partner going through menopause; enduring sleep disturbances, hot flashes, and night sweats; feeling unaroused; or suffering painful intercourse, he begins to feel threatened. He may worry that you are losing interest in him because you no longer feel that he is attractive, wanted, or needed. Or he may just be concerned about you and not wish to upset or hurt you by making an issue of your waning sex life. It is true that in a strong relationship one partner suffers from the other partner’s ills.

It is important for you both to understand what is happening. Therefore, you should learn about and be willing to explain your problem. If you begin taking hormone therapy and feel relief, let your partner know that you feel better, that your sexuality is intact, and that you are interested in sex again. Knowing these things will often enhance his arousal and change problematic sexual activity back into the healthy and satisfactory sex life that you both enjoy. If you are single, HRT may stimulate you to consider and enjoy a new and invigorating sexual relationship.