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.
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