SEXUAL HEALTH & MENOPAUSE

What’s “normal”? Behind any discussion of sexual problems lies an incredibly loaded question: Exactly what is normal, healthy sexual response and function?

The World Health Organization defines sexual health as a “state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity.”

A more comprehensive definition may be hard to come by, since normal sexual response and function is about as individualistic as anything can be. Each person has his or her own standard of what sexual health or satisfaction is, based on his or her individual culture, background, personal sexual experiences, and biological makeup. This individual variation seems to be especially strong among women.

 

Does the problem bother you or your partner?

 

A few basic principles are common to what’s considered healthy sexual response and function for most people:

  • Some degree of desire for sex

  • An ability to enjoy sex

  • Comfort with your level of sexual desire, response, and function

 

The issue is not the sexual “problem” or condition itself but whether it is bothersome or troubling to the person or partners involved.

The question of being troubled is key when it comes to any potential sexual disorder, since the issue is not the sexual “problem” or condition itself but whether it is bothersome or troubling to the person or partners involved. For instance, if both partners in a couple are content to live without an active sex life, then a condition such as vaginal dryness or erectile difficulty does not really represent sexual dysfunction. Similarly, a woman who notices some decline in sexual desire over time may not be troubled by it if she is not in a relationship. However, if she meets a partner with high libido, she may start to see her low sex drive as a problem.

How are problems defined?

 

Sexual response is usually described as having four phases: desire, arousal, orgasm, and resolution. Likewise, sexual problems are often discussed in terms of these phases, so that interest in sex (desire) is understood to be different from the physical changes the body undergoes in anticipation of sex (arousal), both of which are different from the experience of the sex act itself (response/pleasure/orgasm).

 

While all of these phases are related and sexual problems can include elements from more than one phase, different factors can be involved in problems at each phase.

EFFECTIVE TREATMENTS FOR SEXUAL DISORDERS

While the number of potential causes of sexual problems during menopause can seem overwhelming, there are just as many strategies and treatments for overcoming them.

 

These include self-help measures you can adopt on your own, counseling with or without your partner, and prescription therapies or resources that your healthcare provider can direct you to.

 

And these interventions, when properly used, have been shown to be both safe and effective in young, old, and all ages in between.

Treatment for many sexual problems often combines medications or devices with counseling (sex therapy) and/or self-help measures. Rarely does one problem have a single solution that won’t benefit from other treatments or actions. It’s also not uncommon for a woman to experience more than one type of sexual dysfunction, and therapies often overlap among various sexual problems.

This section is organized according to therapies and takes care to identify the problems that each therapy may address. If you’re looking for an overview of therapy options according to each specific sexual problem, check out the table below, which summarizes options in that way.

Therapies often overlap among various sexual problems. Most sexual problems warrant treatment only if they prove bothersome to you or your partner. If neither you nor your relationship is troubled by your problem, taking no action may be the most appropriate course at this time. 

 

 

Low libido/ Low sexual desire

  • First and foremost, examine your relationship and situation: 
    What are the turnoffs? How can they be addressed?

  • Identify medications that may curb desire (such as certain antidepressants or blood pressure drugs) and talk with your provider about lowering the dose or switching to alternatives

  • Sex therapy/counseling

  • Certain testosterone-containing products (not government-approved for treating low desire in women)

  • Bupropion (not government-approved for treating low desire)

  • Yoga

Vaginal dryness/ atrophy

  • Regular sexual activity or stimulation (promotes vaginal health and blood flow)

  • Vaginal lubricants (for temporary relief of dryness before and during sex)

  • Vaginal moisturizers (for longer-term relief from dryness)

  • Low-dose vaginal estrogen therapy in cream, ring, or vaginal tablet form (reverses underlying atrophy and dryness)

  • Higher-dose hormone therapy throughout the body via pills, patches, and other preparations (reverses underlying atrophy and dryness, but generally reserved for women with bothersome hot flashes)

 

Arousal difficulties

  • Topical treatments for vaginal dryness/atrophy (see above)

  • Vibrator or other mechanical devices (eg, clitoral therapy device)

  • Sex therapy/counseling

  • Bupropion (not government-approved for treating arousal difficulties)

  • Viagra-like drugs (PDE-5 inhibitors) to increase blood flow to the clitoris (not government-approved for treating female arousal difficulties)

  • Yoga

Orgasm difficulties

  • Sex therapy/counseling

  • Yoga

Pain during sex

A variety of therapies are available depending on the source of the pain:

  • Vaginal moisturizers, lubricants.  If pain doesn’t improve, see your provider.

  • Vaginal estrogen

  • Sex therapy/counseling

  • Vaginal dilators

  • Pelvic floor physical therapy

  • Kegel exercises

  • Symptom-specific medications (eg, steroid creams for vaginal inflammation, antibiotic creams or pills for vaginal infections)

  • Yoga