sexual behavior has come under the eye of medical scientists, and nowadays
sex-related problems get diagnosed into specific categories. I know it sounds
very sterile and clinical, but this approach does work in addressing the
problem and providing therapy:
complicated. If desire is absent and of no concern to an individual or couple,
there are lots of other ways to be intimate and enjoy life. But the woman who
is bothered and concerned by her loss of desire should express that concern to
her clinician. This does not
necessarily imply that there is something wrong with her body or mind. Perfect
health can be associated with reduced desire. Unsatisfactory personal
relationships, stress, money concerns, lack of privacy, depression, medication
side effects, partner performance issues, and lack of time, are examples of
impediments to desire.
and hormonal changes, as previously described can also be the cause.
should always open the door to discussing sex problems by asking a few
sensitive well-directed questions. Help can come in the form of counseling, or
the selective use of hormones. Hopefully a female testosterone product will
come to market, as testosterone can improve desire.
LACK OF AROUSAL
is possible to want sex, that is to have desire, yet fail to get aroused when
the action starts. Poor arousal usually
can be recognized by a failure of the vagina to lubricate during foreplay. It
can be related to local vaginal atrophy or to central action of some drugs like
antidepressants and antihypertensives. The former is easily cured with local
estrogen or the simple use of lubricants. Some drug side effects may indicate a
need for a change of medication.
sex is either the result of vaginal thinning, or much less frequently a
complication of surgery in the vaginal area. The best treatment for both is
local application of estrogen. It is almost perfect for vaginal atrophy. For
the women with a postsurgical problem not responding to estrogen, a surgical
consultation with a gynecologist may be necessary.
estrogen can be delivered as a cream, a vaginal tablet or a ring. Lubricants or
moisturizers available off the shelf at drug stores work temporarily, but do
not get to the root of the problem. Local estrogen is safe and I encourage its
use. Keep the dose low and use intermittently.
DECREASED FREQUENCY OF SEXUAL ACTIVITY
majority of factors at work with decreased frequency of sexual activity are not
hormonal. Most are related to lifestyle, especially personal
relationships. Issues including
fatigue, competing activities, and tensions in the relationship for a variety
of reasons, are just a few examples of problems that need to be worked out.
Couples need to communicate, and if sex is important, to make as much ‘bed time’
as they devote to other activities. If there is a problem in communication, the
expertise of a sex counselor can be of considerable value.
is part of the arousal factor. Being touched may not elicit the same pleasant
sensation as it did in the past. Decreased estrogen does have an impact at the
level of the brain, as well as on the skin and genital organs, and HT can prompt
nerve endings to recover and grow.
LACK OF ORGASM
satisfaction in women can be achieved without orgasm. But lack of orgasm is a
source of distress for some women. Many factors, as always, are responsible for
the problem, including all the foregoing items I have listed. Interestingly,
orgasms may be experienced before maximum arousal, and further orgasms may
occur at the peak of arousal and during its gradual resolution. Thus for many
women, orgasm and arousal are not particularly distinct entities.
for lack of orgasm really requires a frank discussion with the clinician, and
if the latter is not sufficiently expert or comfortable in providing help, a
skilled sexual counselor is recommended. Some evidence suggests testosterone
may help, but there is no FDA-approved product.
THE MALE PARTNER MAY BE THE PROBLEM
research showed that older men had less interest in sex than older women. This
may have been due to the fact that they were less able to gain and maintain an
erection. The advent of the erectile dysfunction drugs like Viagra, Levitra,
and Cialis may have changed that. Most older men are now able to use these
drugs safely. Many older women in turn have been driven to seek medical help
for one of the abovementioned problems, most notably vaginal dryness causing
pain on penetration.
Next week I will consider some specific issues
concerning lesbians and menopause.
Have a wonderful week.
Utian MD PhD DSc
CHANGE YOUR MENOPAUSE – Why one size does not fit all. http://www.amazon.com/Change-Your-Menopause-size-does/dp/0982845723/