Women are sexual beings throughout their lifespan. Menopause should
not be seen as an end to sexuality or sensuality. While there are some
effects of menopause, sexuality is complex and can be affected by
medications, stress, illness and our attitude towards it. Dr. Nakisbendi
nicely outlines some of the issues surrounding sexuality and menopause.
There is sex after menopause! — Beverly
Vaughn, MD, Medical Coordinator, Menopause and You Program
There are many myths and misconceptions about menopause that can make
women fearful of this transition. One of the greatest myths is that
menopause will cause women to lose interest in sex and that they should
expect their sex lives to dwindle. While many physical and
psychological changes that occur during menopause can affect one’s
sexuality, this does not mean a woman can’t maintain or attain a
satisfying sex life. In fact, there are many positive aspects to
menopause that may help women let go of fears and fully embrace their
sexuality. Sometimes we have to readjust our thinking and broaden our
definitions of sex in order to attain the level of intimacy we desire.
Physical and Emotional Related Causes
Many physical and emotional changes occur in the perimenopausal period
that can affect one’s libido or sexual response. Erratic menstrual
cycles can leave women feeling unsettled as they may rely on their
normal cycle for reassurance that they are not pregnant. The fear of
pregnancy can make it difficult to fully enjoy sexual intimacy. In
addition to changes in their bleeding, women may begin to notice hot
flashes, night sweats, vaginal dryness, memory lapses and even heart
palpitations. These symptoms are typically worse as a woman approaches
her menstrual period. Understandably, these symptoms may leave women
feeling exhausted and short fused. A woman's desire in sex may be
diminished as a result. Some women, though, may experience an increase
in libido during this time because they experience surges in their
estrogen levels. Sometimes this increased libido can interfere with
It is important to realize that every woman’s experience is different.
The variations in how women experience menopause is so vast that
the fear of the unknown can be greater than the symptoms themselves. It
is impossible to predict how a woman will transition through menopause.
In dealing with the loss of sexual functioning, it is essential that
each woman’s situation be fully assessed. While the loss of estrogen and
the decline of androgens can affect sexuality, so can chronic
illness, medications and emotional conflicts. A healthcare provider can
help determine the etiology of the loss of sexual functioning through a
careful history taking.
Illnesses, such as coronary artery disease or diabetes, and
antidepressant medications can all affect libido and sexual response.
Many women are prescribed these medications during the menopausal
period, making it difficult to separate whether the lack of hormones or
the medications are the cause of the dysfunction. While stopping the
medications is not usually an option, discussing alternatives may be the
answer. Many of the antidepressants such as Prozac®, Paxil® or Zoloft®
may cause delayed sexual response and anorgasmia. Sometimes substituting
a medication with a lower sexual side effect profile, like Wellbutrin®,
may ameliorate these symptoms.
Some studies show that adding Viagra® may alleviate some of the sexual
side effects of antidepressants. It is also important to realize that a
depressed person will already be experiencing a decreased libido, and by
treating the depression she may regain her interest in sex no matter
which antidepressant she is taking. Everyone reacts differently, so
patients should not assume that they will experience a loss of sexual
functioning while on these medications.
Sexual Functioning Hormones
Androgens and estrogen are both important hormones for sexual
functioning. Androgens in the form of testosterone and
dehydroepiandrosterone sulfate, or DHEAS, are present in women, albeit
in much smaller quantities than in men. Androgen levels start to decline
in a woman’s thirties and forties. By the time menopause approaches,
these levels have already significantly decreased but then remain at
this lower level. Androgen insufficiency syndrome has been described in
some postmenopausal women or women who have undergone a surgical
menopause as a loss of libido, sexual receptivity and pleasure. There
are saddened or depressed moods and low energy. Testosterone levels in
women experiencing androgen insufficiency syndrome are found to be much
lower than the average in menopausal women. Testosterone replacement in
very small doses in the form of tablets, patches or creams can
ameliorate these symptoms. Patients should be aware that the treatment
of sexual dysfunction with testosterone has not been fully studied.
While side effects can occur, the doses used are usually very small.
Liver function tests may needed in certain situations. The drop in
levels of estrogen during menopause is significant and alone can cause
decreased libido, decreased sensation of the genitals and delayed sexual
response and orgasm. Women may find it takes them much longer to attain
orgasm. Sometimes the use of a vibrator or the Eros-clitoral therapy
device can assist with this by providing stronger stimulation to the
genital area. It is also important to feed one’s mind with sexually
stimulating fantasies through either reading or viewing erotic
Some natural remedies are thought to be beneficial such as L-Arginine,
Yohimbine and DHEA. One must be cautious with any herbal remedy as it
may interfere with other medications or affect a medical condition. This
should be discussed with your physician. Pharmacologic treatments
available include estrogen and progesterone replacement. Even though
there have been studies demonstrating risks with hormone replacement
therapy, it is still a viable option for some individuals as long as all
of the risks and benefits are addressed. Viagra, which has been studied
extensively in men, may help some women as well by increasing the blood
supply to the vagina and the clitoris.
Eliminating Vaginal Dryness
Vaginal dryness is an important symptom to address because it typically
does not resolve and with time may get worse. Due to the lack of
estrogen, the walls of the vagina become thinner or atrophic. The glands
of the vagina become atrophic as well, causing a decrease in
lubrication. This may result in painful intercourse, or dyspareunia.
Dyspareunia alone can cause women to avoid any sexual contact for fear
Over time, this may result in a lack of desire, and a woman may settle
for no sexual intimacy. The good news is that it is treatable! Local
vaginal therapy with estrogen and/or vaginal lubricants usually resolves
this issue. Sometimes vaginal dilators are necessary to help treat
vaginismus, the involuntary contraction of the vaginal muscles, which
can occur after a women has experienced vaginal pain.
Depending on the messages a woman has received in her earlier years and
on the relationships she has experienced, many factors will play into
whether she experiences sexual fulfillment through her menopausal years.
Perhaps the greatest indicator of how sex will be after menopause is to
look at how it was before menopause. While illness, life stresses,
medications, and the loss of a partner can deeply affect a woman’s
sexuality, it doesn’t mean it no longer exists. Some women first realize
in their sixties that they have never had an orgasm and decide it is
time to change that. Some women continue to enjoy using their vibrators
into their seventies! What needs to change is our narrow definition of
sex. If we can expand our minds to include our whole body as a sexual
organ, we will experience greater sexual satisfaction. We should not
view orgasm or vaginal penetration, while satisfying, as the only goal.
When we do that, we limit ourselves and miss out on all the
Whether a woman is single or not, the menopause can be a time to explore
with or without a partner all those things she didn’t have time to look
into before. For those women with a partner, good communication and a
sense of humor are the key elements to a satisfying sexual relationship.
Constantly sharing desires and needs can help a couple make a transition
like menopause easier. A satisfying sexual relationship is a work in
progress. While attaining orgasm may become more difficult as we age, we
might have more fun and laughs along the way.
The best advice for women transitioning through menopause is to address
your fears, educate yourself and find people with whom you can share
your stories. If you are experiencing problems, find a physician who
will address all of your needs and can help you through this process.
There are many options when dealing with the loss of sexual functioning.
Don’t be afraid to ask about them.
This article is part of the Menopause and You library,
a Web-based program sponsored by Women’s Health Source.
It is intended as an information resource providing guidelines for
women. As always, check with your own healthcare practitioner with your
specific concerns and questions.
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