Concern about the safety of hormone replacement has all but obscured one of the most pressing concerns for women of a certain age: the effects of menopause on their sex lives. Many are reluctant to ask their doctors a question uppermost in their minds: “What has happened to my desire for sex and my ability to enjoy it?”
With fully a third of their lives ahead of them, but with little or none of the hormones that fostered what may have been a robust sex life, many postmenopausal women experience diminished or absent sexual desire, difficulty becoming aroused or achieving orgasm, or pain during intercourse caused by menopause-related vaginal changes.
Sometimes the reasons for these problems go beyond hormones. Some women may consider themselves less sexually attractive as their bodies change with age, or they have partners who have lost interest in sex or the ability to perform reliably.
But for most postmenopausal women, hormone-related changes are the primary factors that interfere with sexual satisfaction. My friend Linda, for example, who lives in Pittsburgh, was 52 years old and recently married when her vibrant interest in sex suddenly plummeted, leading to a search for a way to restore it.
A more common situation is described by Pat Wingart and Barbara Kantrowitz in their informative book, Is It Hot in Here or Is It Me? (Workman, 2006): “You’re not in the mood a lot of the time. Most nights, you just wish your partner would roll over and go to sleep. When you do feel like a little action, it takes forever to get warmed up. Sometimes sex is more painful than pleasurable.”
COMMON CHANGES
Unlike Linda, who had an abrupt change in desire, many women report a gradual decline in sexual desire as they age. In a survey of 580 menopausal women conducted by SIECUS, the Sexuality Information and Education Council of the United States, 45 percent reported a decrease in sexual desire after menopause, 37 percent reported no change and 10 percent reported an increase.
Although individual experiences certainly vary, “Changes in arousal clearly are associated with menopause,” according to a 2007 article in the Journal of the American Medical Association. The author, Jennifer E. Potter of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, said physical factors include less blood flow to genital organs, a decrease in vaginal lubrication and a decreased response to touch.
Women can achieve orgasm throughout their lives, but they typically need more direct, more intense and longer stimulation of the clitoris to reach a climax, Potter noted.
Another common experience is a diminished intensity of orgasm and painful uterine contractions after orgasm, although the women surveyed by SIECUS said overall that they remained satisfied with sex.
Yet as Potter put it, “What might be a satisfying sexual life for one woman may seem woefully inadequate to another,” adding that what a woman expects from her sex life can make a difference. She cited the findings of various large surveys: “Only one-third to one-half of women who report decreased desire or response believe they have a problem or feel distress for which they would like help.”
So what happens to a woman’s body when levels of sex hormones fall?
Although estrogen is a woman’s predominant hormone before menopause, testosterone, produced in women primarily by the ovaries and adrenal glands, is considered the libido hormone for both men and women.
Testosterone levels in women decline by about 50 percent between the ages of 20 and 45, and the amount of testosterone produced continues to decline gradually as women age. While menopause itself has no direct effect on testosterone production, surgical removal of the ovaries can cause an abrupt drop in this hormone and accompanying sexual desire, especially for women who have not gone through natural menopause.
For some women, the increased ratio of testosterone to estrogen that occurs after menopause gives their sex drive a boost, the authors Wingart and Kantrowitz point out.
But for most women, the menopausal effects of low levels of estrogen are the primary deterrents to sexual pleasure. In addition to the infamous hot flashes, changes in the vagina and vulva can have serious effects on the sexual experience.
— With little or no estrogen, vaginal walls become dry, thin and less elastic, causing pain during penetration.
— Diminished blood flow to the genital area means it can take much longer for a woman to feel aroused.
— The anticipation of painful uterine contractions with orgasm can be a turnoff.
— A leakage of urine some women experience during sex can prompt them to avoid it.
HELPFUL TREATMENTS
Linda, who asked that her last name not be used, said she was more concerned about reviving her sex life than a possible increased risk of hormone-induced cancer or heart disease. A prescription of the drug Estratest, which combines estrogen and testosterone, solved her problem.
But taking estrogen orally is not recommended for women who have had breast cancer or are at high risk for developing it. Also, to protect the uterus against cancer, estrogen should be combined with a progestin.
An alternative that works for some is vaginal application of a little estrogen via a cream, ring or tablet, which keeps the hormone from passing through the liver and diminishes the amount that enters the bloodstream.
Gynecologists concerned about safety are more likely to recommend a non-oil-based lubricant. Besides popular products like K-Y jelly, Wingart and Kantrowitz suggest several longer-lasting products that have an adhesive quality, including Replens, K-Y Long-Lasting Vaginal Moisturizer and Astroglide Silken Secret. The authors said “women who have intercourse regularly seem to generate more lubrication than those who do it less frequently.”
Infrequent intercourse or prolonged periods without it can result in a narrowing of the vagina that can be countered by the use of lubricated vaginal dilators. For women whose sex lives are disrupted by lack of a partner, the authors recommend self-stimulation. Potter suggested that even for women with partners, a vibrator or small battery-powered vacuum pump can aid in arousal.
While a Viagra-like drug is not yet an option for women, use of the antidepressant bupropion (Wellbutrin at 300mg a day) may improve sexual arousal and satisfaction in women who are not depressed. And Potter pointed out that remaining physically fit can also help.
April 28 to May 4 During the Japanese colonial era, a city’s “first” high school typically served Japanese students, while Taiwanese attended the “second” high school. Only in Taichung was this reversed. That’s because when Taichung First High School opened its doors on May 1, 1915 to serve Taiwanese students who were previously barred from secondary education, it was the only high school in town. Former principal Hideo Azukisawa threatened to quit when the government in 1922 attempted to transfer the “first” designation to a new local high school for Japanese students, leading to this unusual situation. Prior to the Taichung First
When the South Vietnamese capital of Saigon fell to the North Vietnamese forces 50 years ago this week, it prompted a mass exodus of some 2 million people — hundreds of thousands fleeing perilously on small boats across open water to escape the communist regime. Many ultimately settled in Southern California’s Orange County in an area now known as “Little Saigon,” not far from Marine Corps Base Camp Pendleton, where the first refugees were airlifted upon reaching the US. The diaspora now also has significant populations in Virginia, Texas and Washington state, as well as in countries including France and Australia.
On April 17, Chinese Nationalist Party (KMT) Chairman Eric Chu (朱立倫) launched a bold campaign to revive and revitalize the KMT base by calling for an impromptu rally at the Taipei prosecutor’s offices to protest recent arrests of KMT recall campaigners over allegations of forgery and fraud involving signatures of dead voters. The protest had no time to apply for permits and was illegal, but that played into the sense of opposition grievance at alleged weaponization of the judiciary by the Democratic Progressive Party (DPP) to “annihilate” the opposition parties. Blamed for faltering recall campaigns and faced with a KMT chair
Article 2 of the Additional Articles of the Constitution of the Republic of China (中華民國憲法增修條文) stipulates that upon a vote of no confidence in the premier, the president can dissolve the legislature within 10 days. If the legislature is dissolved, a new legislative election must be held within 60 days, and the legislators’ terms will then be reckoned from that election. Two weeks ago Taipei Mayor Chiang Wan-an (蔣萬安) of the Chinese Nationalist Party (KMT) proposed that the legislature hold a vote of no confidence in the premier and dare the president to dissolve the legislature. The legislature is currently controlled
RSS