Menopause

All three stages of the human sexual response cycle (desire, arousal, and orgasm) can be affected by the hormonal changes of menopause.

Sexual desire is mainly modulated by testosterone. Women with decreased desire due to low testosterone respond with increased sexual frequency and improved sexual pleasure. Estrogen contributes in a limited way to desire, primarily by reducing the negative effects of vaginal atrophy. Otherwise, the effects of estrogen on desire are limited. Testosterone replacement for women is a rapidly advancing field, with oral and injectable forms, topical creams, patches, and implantable pellets all being available.

The loss of natural estrogen can lead to vaginal dryness and lack of lubrication, which HRT can help. Estrogen can be given in a number of ways as well, with vaginal cream, oral pills, patches, and injectable medications being available. All have similar effectiveness, although the intravaginal cream provides the most rapid healing for vaginal atrophy.

When given over an extended time, estrogen must be given in combination with progesterone to reduce the risk of uterine cancer. Most women notice little change on their sexuality from progesterone therapy. Those women who have had a hysterectomy do not need to take additional progesterone.

For some women, the use of HRT is generally contraindicated (such as those with advanced breast cancer.) For those women not responding to alternative therapies, local vaginal symptoms can be treated using a soft plastic pessary (Estring™) that is impregnated with estrogen. It is only locally absorbed and is believed to not increase the risk of cancer recurrence.

Many women who loose the intensity, or even the capacity, to orgasm after menopause will benefit from replacement testosterone. This is especially noticeable after surgical menopause (the operative removal of both ovaries, which causes a sudden loss of estrogen). Sexual satisfaction, as well as overall psychological well-being is generally improved by testosterone replacement.

Some women may not be able to take HRT for medical or personal reasons. Nearly half of adults have used alternative therapies in the last year. There is great clinical demand to have more products available to help these women. While there has been an increase in sexual health research, especially for men, there are still many more questions than answers that await study to demonstrate effective therapies for women. Many alternative products exist to try to help women with menopausal, including sexual, concerns. Some of these include phytoestrogens, dong quai, evening primrose oil, black cohosh, and ginkgo biloba. Few of these have been evaluated using placebo-controlled studies, and some have negative side-effects and interactions with other medications. Given the strong psychological effect on sexual function of taking a placebo, these therapies need to be viewed with caution.

Specific products for post-menopausal vaginal dryness include Replens™, which is a longeracting vaginal moisturizer that is inserted into the vagina every few days as needed. This is helpful for nonsexual sensations of vaginal dryness.

Other nonhormonal options that are effective include vaginal artificial lubricants to help with intercourse, such as Astroglide™, Just Silk™ and K-Y™ personal lubricant. All of these are safe to use with condoms. Oil-based products, however, can cause condoms to leak. The use of unscented oils, such as peanut oil and Alpha-Keri Bath Oil™, is also more acceptable than petroleum jelly, which is too sticky.

There are no other aphrodisiacs better than a placebo available to help women have more sexual desire or better orgasms.