SEX AND MENOPAUSE

The effect of menopause and aging on sexual health can vary widely. Most women experience some changes in sexual functioning as they age but menopause and aging do not signal the end of a woman's sexual life.

Some women experience decreased sexual desire or pain with sex. There are a variety of causes for the decrease in sex desire. including relationship problems, depression, medication side effects, chronic health problems, hormonal changes of aging, partners' sexual dysfunction (such as erectile dysfunction) or pain with sex.

The decrease in sexual desire can be related to a decrease in testosterone level but often is not. Most women don't have a dramatic change in testosterone level in perimenopause or menopause and one's testosterone level (blood or salivary test) doesn't correlate with level of sexual desire. Some women with a higher testosterone level have decreased sex desire and other women with a lower level of testosterone have no problems with low sexual desire.

If a woman has had surgical removal of her ovaries (surgical menopause) or induced menopause, the testosterone level may be unusually low and a trial of testosterone can be tried for decreased desire.

Your provider can review your medication list to see if a medication could be causing decreased sexual desire and if it can be improved upon. If you are with a partner you can explore if there are issues within the relationship which may need attention with an individual or couples therapist. If there is an underlying depression, treatment options for this can be considered. If a male partner has developed sexual dysfunction, a consultation with a urologist might be helpful. Pelvic floor physical therapy or working with a sex therapist may also be recommended.

Many women experience changes in sex desire due to the development of pain with sex, which can often be successfully treated. Due to lower levels of estrogen and decreased blood supply, the vaginal and bladder tissues become thin and easily irritated.

There are several options to treat these symptoms. There are over the counter products, prescription medications and mechanical treatment options.

Over the counter products include moisturizers and lubricants. Moisturizers are vaginal cream/gels that are used as needed for comfort and are not related to sexual activity. Lubricant are vaginal gels that are used with sexual activity.

The prescription medications include vaginal estrogen tablets, vaginal estrogen creams, vaginal estrogen rings, vaginal DHEA creams and oral SERM (selective estrogen receptor modulator) tablets.

The pain is often greatly improved after 6 weeks of using one of these medications. You need to continue to use the medication to prevent the recurrence of the vaginal dryness and pain. Using a vaginal estrogen or DHEA does not have the risks nor benefits of systemic hormone therapy as the dose of medication used is very small and only small amounts get into the bloodstream. It would not help with other symptoms like hot flashes but also has fewer risk than whole-body hormone therapy.

Mechanical options increase blood supply to the vulvovaginal tissue. Sexual activity (with or without a partner) helps maintain healthy vaginal tissue and decreases vaginal dryness. Vaginal dilators and pelvic floor physical therapy can also be helpful for some women.

If all these issues have been considered and low sexual desire persists, a trial of testosterone supplementation may be explored as an option. Working with a sex therapist can also be helpful.

The Menopause Society has a great overview of many topics including normal changes, common problems and treatment options at

http://www.menopause.org/for-women/sexual-health-menopause-online