Mid-Life Sexuality in Women

Mid-Life Sexuality in Women

Female Sexual Dysfunction is most common between the ages of 45-65. This is due to many factors, some of which can be improved with education and communication. Problems can relate to diminished desire or arousal, pain with intercourse, or difficulties with orgasm. Of course any one with pain will also have a decrease in desire, so solutions may need to address several areas of concern.

Sexual desire

Decreased libido, or loss of desire, can be caused by body issue concerns (feeling unattractive due to weight gain or other signs of aging) or relationship issues. Chronic illness, medication effects, life stressors, depression, hormonal factors, and substance abuse may all inhibit desire. Chronic illnesses, especially the Rheumatologic diseases and obesity, may require position changes, bolsters, or oral sex. Medication changes can be discussed with your physician. Decreasing your outside responsibilities (work, caretaking, etc.) and practicing meditation or yoga can help with stress. The loss of estrogen at menopause can cause depression or sleep problems. Menopausal hormone therapy can help mood, sleep quality and increase energy.. Length of relationship is the number one predictor of decreased libido. Excitement needs to be reintroduced. Areas of conflict over money or family concerns often lead to decrease in intimacy. Affairs can also impact the relationship. Relationship issues may need to be addressed with individual or marital counseling.

Hormonal Factors

The levels of testosterone gradually decline with age. Surgically menopausal women who have had their ovaries removed lose about ½ of their testosterone. There are no FDA approved products for women, but testosterone therapy can help some women. It is very important to have regular blood levels however, because there are also risks with testosterone therapy. There is a new FDA approved pill for women, however, there are a lot of side effects & it must be taken every day & you cannot have any alcohol while using it. Although it was only approved for premenopausal women, it does work in some postmenopausal women.

Sexual Arousal

Decreased arousal is caused by decreased blood flow to the genitals, medications such as antidepressants and by lack of the right type of foreplay. Medication changes can be discussed with your physician. More foreplay, especially to the clitoris may be needed. It is important to communicate to your partner what type of stimulation feels best to you. There are sex toys that improve arousal (a new one is called Fiera). Oral over the counter products include Arginmax (use with caution if you have high blood pressure or herpes) & Stronvivo (a vitamin product that actually showed improvement in a scientific study). Topical products for “increased pleasure” (Zestra and others) are available, but they can be irritating to menopausal skin.
Orgasms are more difficult to achieve after menopause due to decreased blood flow to the genitals. Any of the options discussed under decreased arousal can help. Also, there are books with specific pointers. “For Yourself” by Lonnie Barbach, PhD has been around for years. Another book is “She Comes First” by Ian Koerner, PhD..

Painful Sex

Pain with intercourse can be caused by vaginal dryness due to medications, lack of hormones, and long breaks without intercourse due to divorce, death or prolonged illness of a partner. Particularly in women who have not had a vaginal delivery, decreasing frequency of intercourse can lead to pain. Systemic (whole body) or vaginal estrogen products are available by prescription. There is one prescription oral pill for pain due to vaginal dryness (Osphena). Lubricants need to be applied to both partners (before and during intercourse) and especially around the clitoris and labia. There are many brands but the least irritating ones are Pre-seed, FemGlide, Slippery Stuff, and Pink. For women who have had a long break without intercourse, vaginal dilators can be used to stretch the vagina. For women who have developed muscle tightness as a response to the pain, physical therapy for the pelvic floor muscles is available. Position changes, particularly female on top, can also help. There are also studies coming out about using cosmetic surgery tools inside the vagina to stimulate collagen formation. A laser procedure and a radio-frequency device are currently available but are not covered by insurance.

The first step to solving any problem is to recognize that it exists. Set realistic expectations. Try new things. Behaviors may need to be altered. Below is a list of general information that may be helpful.

  1. Moisturize daily.
    Menopausal skin is often more sensitive & requires more care. Avoid soaps & bubble baths. Rinse very well with warm water. Pat dry. External moisturizers include Lubrigyn, Neogyn, JuvaGyn, & AloeGlide. Internal moisturizers are usually used 2-3 times/wk., not before intercourse. These include Hyalo-Gyn (scientifically shown to be as good as estrogen), Replens, Luvena, & KY Liquibeads.
  2.  Nourish.
    Good nutrition & regular exercise are not only important for general well-being, but they increase blood flow to the genitals. This can also help with weight issues. The Mediterranean diet is a good choice.
  3. Talk.
    It is important to be honest with your partner. Explain what is changing with your body & the importance of adapting your sex life with aging. Concentrate on intimacy, not performance.
  4. Prioritize pleasure.
    Set aside 20 min. per week of “sacred time” for talking & touching, even if it doesn’t lead to intercourse. Hugging & kissing improve intimacy. Fatigue often causes decreased desire due to the physical & emotional demands of the day. Perhaps morning would be a good time for intimacy.
  5. Think.
    Although women can be aroused & willing for sex, libido usually comes from the brain. Reading erotica or romance novels can help. Also, during the encounter, concentrate on the sensations, not on your “To Do” list.
  6. Stimulate.
    In order to increase the blood flow to the area, it is important to stimulate the genitals regularly (at least weekly). This can be done with sex toys (vibrators, etc.) or masturbation. This is especially important for women without a current partner.
  7. Get started.
    Making an attempt to improve your sex life tells your partner that you care about the relationship.