How does menopause affect your sex drive?

The loss of estrogen following menopause can lead to changes in a woman's sexual functioning. Menopausal women may notice that they are not as easily aroused, and may be less sensitive to touching and stroking, which can result in decreased interest in sex. Further, the emotional changes that often accompany menopause can add to a woman's loss of interest in sex and/or inability to become aroused.

In addition, lower levels of estrogen can cause a decrease in blood supply to the vagina. This decreased blood flow can affect vaginal lubrication, causing the vagina to be thin, pale, and dry. The lower one-third of the vagina can shrink, leading to painful sexual intercourse.

A lower estrogen level is not the only culprit behind a decreased libido; there are numerous other factors that may influence a woman's interest in sexual activity during menopause and after. These include:

Do all menopausal women experience a decrease in sexual desire?

No. In fact, some post-menopausal women report an increase in sexual satisfaction. This may be due to decreased anxiety associated with a fear of pregnancy. In addition, many post-menopausal women often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners.

What can I do to treat vaginal dryness?

Vaginal dryness can be treated with over-the counter water-soluble lubricants such as Astroglide® or K-Y Liquid®. Do not use non-water soluble lubricants such as Vaseline® because they can cause irritation and weaken latex (the material used to make condoms).

Some women prefer silicone-based lubricants. Silicone lubricants should not be used with sexual stimulating devices made from silicone (sex toys), as it can make it hard to keep them clean.

Condoms should continue to be used to avoid pregnancy until your doctor verifies you are not producing any more eggs and also to prevent contracting sexually transmitted infections.

Estrogen may be used to improve the integrity of the vaginal tissue. This can be prescribed to be used in low doses directly inside the vagina (including creams, pills, and vaginal rings).

Hormone therapy can also be taken at higher, systemic doses, where it can have additional benefits and risks. Ospemifene (Osphena) is a non-estrogen pill that is taken by mouth. Its benefits to the vagina are similar to that of estrogen. Serious but uncommon side effects can include blood clots, and stimulation (thickening) of the lining of the uterus. Some women may also notice more hot flashes, vaginal discharge, and muscle spasms, though the majority of women will have no symptoms.

How can I improve my sex drive?

Currently, there are not any good drugs to treat sexual problems in women. Estrogen replacement may work, but research has yielded conflicting results regarding its effectiveness. Estrogen can, however, make intercourse less painful by treating vaginal dryness.

Although sexual problems can be difficult to discuss, talk to your doctor; there are options to consider, such as counseling. Your doctor may refer you and your partner to a health professional who specializes in sexual dysfunction. The therapist may advise sexual counseling on an individual basis, with your partner, or in a support group. This type of counseling can be very successful, even when it is done on a short-term basis.

What can I do to increase intimacy with my partner?

If your sex drive isn't what it once was but you don't think you need counseling, you should still take time for intimacy with your partner. Being intimate does not require having intercourse--love and affection can be expressed in many ways. Enjoy your time together--you can take long romantic walks, have candlelit dinners, or give each other back rubs.

To improve your physical intimacy, you may want to try the following approaches:

  • Educate yourself about your anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and responses. This may help you overcome your anxieties about sexual function and performance.
  • Enhance stimulation through the use of erotic materials (videos or books), masturbation, and changes to sexual routines.
  • Use distraction techniques to increase relaxation and eliminate anxiety. These can include erotic or non-erotic fantasies; exercises with intercourse; and music, videos, or television.
  • Practice non-coital behaviors (physically stimulating activity that does not include intercourse), such as sensual massage. These activities can be used to promote comfort and increase communication between you and your partner.
  • Minimize any pain you may be experiencing by using sexual positions that allow you to control the depth of penetration. You may also want to take a warm bath before intercourse to help you relax, and use vaginal lubricants to help reduce pain caused by friction.

Do I still have to worry about sexually transmitted infections?

Yes. Just as you must use protection if you do not want to become pregnant during perimenopause, you must also take measures to protect yourself against sexually transmitted infections (STIs) during menopause and postmenopause. It's important to remember that your risk of contracting STIs is a possibility at any point in your life during which you are sexually active, and this risk does not go down with age or with changes in your reproductive system.

Left untreated, some STIs can lead to serious illnesses, while others, like AIDS, cannot be cured and may be deadly.

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