Menopause

Menopause frees a woman's sexuality from fear of pregnancy. Up to 70 percent of women note no effects of menopause on their sexuality. These women are more likely to be in mature relationships and have worked through relationship issues that can otherwise confound sexual intimacy. Women who have previously had an active, comfortable sex life tend to have fewer problems with post-menopausal sexuality. The stimulation of intercourse helps keeps the vaginal mucosa thickened and more youthful, supporting the old adage of "Use it or lose it." Cultural values may also play a role in how menopause affects sexuality. In societies where the elderly are more likely to be respected for their wisdom, such as in Japan, most women make the transition through menopause with far fewer symptoms than women in the West.

The most common change in sexual function in menopause is decreased vaginal lubrication in response to sexual stimulation. This loss of arousal can lead to sexual pain, reduced orgasmic intensity, and, ultimately, in decreased desire. Much of this can be helped by taking replacement estrogen. Desire and orgasmic capacity can drop on their own as a result of menopause, independent of any pain or discomfort. Many women loose the sense of sexual passion. These changes can be due to decreased testosterone.

The menopausal woman is not the only one going through changes at this point in her life. Married women's husbands are dealing with their own physical changes. The slowing of the sexual response allows many couples to savour their sexual interaction, in contrast to the mad rush of youth. While it takes longer for both men and women to get aroused, lovemaking can last longer due to the aging male's decreased pressure for orgasm. Indeed, many older men do not need to ejaculate in order to enjoy the sexual experience. For most, this is an enjoyable experience. For some couples, however, not understanding the physical changes that go with aging creates concerns. Some women, having been used to a stronger sexual response from their partner, personalize these changes and wonder if they are no longer seen as attractive by their mate, or if he is having an affair. This often increases the pressure to perform that is already worrying the man, who may be wondering if he is developing impotence.

When women have sexual dysfunction, about half of their partners will also have sexual difficulties of their own. Women who have no sexual difficulties may still have to deal with their partner's loss of potency. Male erectile dysfunction increases with age, with complete loss of erection occurring in 5 percent of men at forty, and increasing to 15 percent by age seventy. More than half of older men have some partial degree of erectile dysfunction that interferes with sexual intercourse. Most erectile dysfunction in men is not due to hormonal changes, but rather to aging of blood vessels and the mechanisms that increase the blood flow to the penis. The revolution brought about by Viagra™ and other therapies can often help men and women dealing with these difficulties.

Men also appear to go through a male menopause. In contrast to women, men have a more gradual decline in their own testosterone, starting in the late forties and continuing over the next two to three decades. This results in similar changes seen in women, including decreased desire and orgasmic drive, and ultimately in the loss of erections.

Many women become single, either through widowhood or divorce, in the years following menopause. For many this leaves them to deal with their sexual needs alone. Women who reenter the world of dating and becoming sexual with a new partner face a number of concerns. The vaginal changes of menopause leading to atrophy and loss of elasticity progress more quickly if a women is not sexually active. If a woman has not had a partner for a long time, she is at increased risk of having discomfort. This can usually be treated with local estrogen. Many physicians desexualize their older female patients and do not think to counsel them about safe sex. Many older women are not conscious of the risks of sexually transmitted disease in this population. The thinner vaginal walls are more vulnerable to infection with intercourse. While numbers are still small, the greatest rate of increase in HIV/AIDS is in women over fifty.

Women in menopause are aging and may have other medical illnesses that can affect sexual function. Hypertension, diabetes, depression, and heart disease are but a few examples that can have profound effects on sexual function. The drugs used to treat these conditions frequently have sexual side-effects as well. Antidepressants commonly cause sexual difficulties, decreasing desire, arousal, and orgasm for both women and men.

Many sexual concerns during menopause are not related to hormonal changes at all. Sexual behavior involves an interaction between two people. Women are generally more sensitive to the context and connection they feel within the relationship than men are, and sexual dysfunctions are often symptomatic of other stresses, either on an individual or a couple. Sex can deteriorate due to psychological problems for either partner, or due to relationship strains. Effective treatment of sexual concerns needs to take into account the physical and psychological health of both partners, as well as the state of their relationship both inside and outside of the bedroom.