Sex & Menopause Why Bother?

Menopause is a process, not an event. Menopause is not a disease, does not always need treatment, and does not get “cured.” Rather it is a time of transition, with lots of changes in a woman’s body, not unlike the changes we understand as normal during puberty. It begins with a decline in estrogen production that ultimately results in cessation of ovulation, but a woman’s last period is by no means the end of the process. There are many adjustments that continue over time

A very, very common experience of menopausal and post-menopausal women is a major change in their libido, which, like other symptoms of menopause, results from the lack of estrogen. Women often tell me they have less interest in sex, they don’t feel the same,  don’t function the same, and they may think, “It’s all over for me.”

I think it is very important when you look at something like the Masters and Johnson model of sexual function, which envisions a start, a peak, and a finish to sexual activity, that you realize that process may be true in younger women and it may be true in men, but it is not true in menopausal women. Interestingly, a Vancouver-based researcher named Rosemary Basson proposed a different reality, one that has become well accepted in the medical community. Based on her research, first published in 2001, she has created a schematic diagram illustrating sexual function in women as they age, and that diagram portrays sexual experience not as a line with a start and a finish but rather as a circle.

Her research shows that, with menopause, women often lose interest in initiating sexual activity; however, if they are intimate, if they are close with their partner and the partner begins sexual activity, they can derive pleasure from it. I think her model is much more accurate regarding how women function because I know that a lot of the women in my practice feel this way. But many women, because they have lost interest in initiating sexual activity, and because the idea of sex doesn’t have the same appeal, often say, “No way. Why bother?”

It’s Not Just You

When I talk to women in my practice about sexual issues they often respond with a huge sigh of relief. Women tend to think it’s a completely personal problem; they think it is just about them or about their partner or their relationship. So, it is extremely reassuring for them to learn about Basson’s research. They say things like, “Oh! You mean it’s not just me?” And they begin to see possibilities for maintaining and deepening their relationship, possibilities they thought no longer existed for them. And so I do encourage women to maintain intimacy, to maintain closeness, and to allow themselves to continue to be involved sexually with their partner, because generally once they start and once they get involved they can go through that circle and to derive pleasure from the activity itself and satisfaction from the ongoing intimacy.

One menopausal symptom that does not go away with time is the genitourinary syndrome of menopause. That term may sound off-putting, but it is more medically accurate—and perhaps less alarming—than the name that was previously used: vaginal atrophy. So, what is it? Because of lack of estrogen the vagina gets dryer and the back wall of the bladder loses its estrogen support. This results in vaginal symptoms like dryness, burning, and itching; it also causes bladder symptoms such as loss of control and results in an increased risk of bladder infections.

Don’t get me wrong: estrogen is not a panacea; it does not solve everything. Adding back estrogen does not necessarily replace lost interest or replace the physiological response so that it is the same as when you were 30. But adding back estrogen can lubricate and make you more comfortable, and for many women, it is discomfort that convinces them they are past the time when sex can be good, can be enjoyable for them.

In Chapter 5 of my book, A Woman’s Guide to Healthy Aging- 7 Proven Ways to Keep You Vibrant, Happy & Strong, I go into a great deal of detail about hormone treatments and various options.


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