The Physical Impact of Changing Hormones
Attitude is one thing, but there is no denying that as hormones change, so does your body. What physical symptoms and changes can interfere with sexual desire and pleasure as menopause approaches? Here are the most common:
Pain during penetration
Reduced response to clitoral stimulation and other sexual stimuli
Some of these changes are normal parts of the aging process and don't represent alarming signals that sexual life is drawing to a close. Women (and men, for that matter) typically experience a slowdown in their biologic sexual response. Women may take longer to become aroused, for example, and some women report that they have fewer orgasmic contractions and shorter orgasms in general. These changes may mean that lovemaking takes on a new schedule or some new practices — changes that can benefit lovemaking at any age. Other physical changes are transient and treatable, either with medical hormonal therapies or nonhormonal, natural techniques.
But a maturing woman can undergo a number of physical and medical events that can trigger the symptoms and conditions of flagging sexual health, as well. These events include:
Illnesses, both physical and emotional, including (but not limited to) cardiac problems, hypertension, cancer, bladder disease, depression, and arthritis
Medications used to treat any of the above illnesses, including some blood pressure medications, antidepressants, tranquilizers, and antihistamines
Medical treatments, such as radiation therapy, chemotherapy, or surgery
Don't get the impression that if you take blood pressure medication or undergo surgery that you're embarking on a life of sexual abstinence. Sexual dysfunction resulting from illness or long-term treatments such as chemotherapy can pass as the illness and treatment side effects fade. A number of alternative medications can replace those that create sexual problems.
Hormones and Sexuality
Hormones — especially estrogen — play an important role in your body's sexual response. Estrogen helps to nourish all of your body's tissues, including your vagina, vulva, and urethra. Estrogen also helps keep the clitoris well nourished and responsive; with less estrogen, the clitoris can lose some of its ability to respond to touch.
As your vaginal wall becomes thinner and drier, your vagina can become shorter, narrower, and less elastic. This is called vaginal atrophy and when it becomes severe, sex can be quite painful. Lack of lubrication and vaginal walls that just won't give can make sex less appealing — to both you and your partner.
A lack of estrogen will also result in a change in the normal vaginal pH and lower levels of lactobacillus, the normal bacteria that helps ward off most vaginal infections in reproductive age women. Thus, if your vagina goes through marked changes in pH levels, you may find that you're more susceptible to vaginal infections. These infections can make your vagina feel raw and irritated, create abnormal vaginal discharge, and make sexual intercourse a painful, burning experience. Estrogen therapy can improve vaginal secretions and tone. To reduce the risks from oral or transdermal (also called “the estrogen patch”) estrogen therapy, you might want to consider getting estrogen from a vaginal cream. This cream may take a few months to reverse the changes in the vagina, especially if you have been without any estrogen for a long time. But it is absorbed only locally (in the vaginal area), and does not carry the risks of systemic estrogen.
Hormones play another critical role in strengthening or diminishing the libido; the sex hormones — estrogen and progesterone — contribute to mood. If you grow anxious, depressed, irritable, or exhausted as a result of hormone deficiencies, your sex life can suffer.
Testosterone treatment for women with marked decrease in sexual desire is controversial. Some studies seem to show that women can benefit from testosterone to renew their sex drive. But the FDA has not yet approved these treatments and appropriate dosages are not yet clear. The side effects of lowering your “good” cholesterol, acne, and excess body hair can also be undesirable.
Overcoming Physical Barriers
Although you can't postpone menopause or the effects of aging indefinitely, you don't have to let some of the physical symptoms of menopause prevent you from remaining sexually active. Your doctor can recommend treatment options, exercise, dietary or medication changes, or other therapeutic solutions that can lessen or even resolve your physical barriers to an enjoyable sex life. And, as with all aspects of your health care, you may be able to improve your sexual health through some changes in your lifestyle choices.
The same stresses, habits, and substances that damage other aspects of your health can limit your desire and ability to enjoy sex, as well. Here are some basics for maintaining your sexual fitness:
Eat right and exercise regularly. Nutrition and exercise are just as important for sexual health as for general physical and emotional health. Regular aerobic, weight-bearing, and stretching exercises keep your body feeling active and alive. When your body is strong and fit, you're more energetic and you take a greater interest in all aspects of your life — including sex.
Rest and manage stress. If your daily routine is too overwhelming to allow you to enjoy an active sex life, it's probably damaging your health in other ways. Stress can lead to headaches, indigestion, muscle pain, depression, and — not surprisingly — a diminished desire for and response to sexual activity. Learn what's causing your stress, then do what you can to avoid the stressors.
Cut down on alcohol and stop smoking. Most medical experts agree that one or two alcoholic drinks a day aren't bad for your health (unless you have conditions or are taking medication that precludes the use of any alcohol). But drinking too much alcohol can lead to depression, weight gain, and — in some cases — an increased stress response. Smoking fuels stress, as well, and it saps your body of strength and energy. All of these effects can erode your interest in sexual activity and dampen your response to sexual stimulation.