Attention, Menopausal Women

The three most common causes of sexual dysfunction are treatable.


Attention, Menopausal Women

Menopause: The Good and the Bad

For some women, menopause is a time of liberation. No longer saddled with fear of getting pregnant, they find their desire increases, and they can be more spontaneous with their partner.

But for other women, menopause brings declining desire or uncomfortable intercourse—leaving them, as well as their spouses, sad and confused. But it doesn't have to be that way.

The most common causes of sexual dysfunction after menopause are treatable. Understanding the cause of your particular problem is the first step to restoring a satisfying sex life, says Margery Gass, MD, Executive Director of the North American Menopause Society (NAMS) and a consultant in Cleveland Clinic's Center for Specialized Women’s Health.

Knowing What's Not Normal for You

Every couple's sex life is different, and there is no such thing as “normal.” Nevertheless, changes in your sex life that cause unhappiness are not normal after menopause.

“The signs and symptoms of sexual dysfunction are feelings that your sex life is not the way you want it to be, and it is causing you concern and distress,” says Dr. Gass.

The three most common causes:

  1. Hormonal changes
  2. Health issues
  3. Lack of desire

All three are treated in different ways.

Problem #1: Painful Intercourse

The most common symptom women notice at menopause is a decrease in vaginal lubrication, which can make intercourse painful. There are three approaches that can help:

  1. Lubricants
  2. Moisturizers
  3. Vaginal estrogen

“Vaginal estrogen therapy is the only approved prescription drug therapy for this condition. It effectively restores the vaginal mucosa to a premenopausal state,” says Dr. Gass. “A moisturizer used regularly a couple times a week (not at the time of intercourse) may be helpful.”

Hypersensitivity at the entrance to the vagina is a common problem that does not necessarily improve with lubrication. If the dryness does not disappear easily, see your gynecologist, advises Dr. Gass.

Painful intercourse can also be caused by endometriosis, a pelvic mass, ovarian cysts, vaginitis, scar tissue from surgery or a sexually transmitted disease. So it's wise to have a checkup if you are experiencing painful intercourse.

Problem #2: Poor Health or Fitness

Many common medical conditions and medications can interfere with sexual performance and desire.

Studies have found that women ages 50 to 79 years have less sexual activity if they are overweight, or have poor-to-fair health, arthritis or a history of heart attack. The following risk factors can also cause sexual dysfunction:

  • Diabetes
  • High blood pressure
  • Excessive alcohol use
  • Stress
  • Fatigue

“Older women need to stay fit to maintain their sexual functionality. This means avoiding excess weight, controlling cholesterol, and preventing or managing diabetes,” says Dr. Gass.

For unavoidable problems, such as cancer, chemotherapy, arthritis or surgery, Dr. Gass suggests being creative. She encourages couples to consider alternate ways to be intimate and achieve orgasm, including massages, different kinds of lubricants and sexual toys.

High blood pressure medicine, antidepressants and chemotherapy are among the many medications that can cause sexual dysfunction. If you feel a medication may be responsible, Dr. Gass suggests asking your doctor if a substitute medication would work.

Problem #3: Lack of Desire

Emotional changes that often accompany menopause can cause a woman to lose interest in sex. However, Dr. Gass stresses that lack of desire is different from lack of sexual enjoyment.

“Women without desire can still enjoy sex once they get into it,” she says. She recommends assessing what might be preventing you from being interested. Common factors are:

  • Stress
  • Fatigue
  • Relationship issues
  • Sexual boredom

Reading erotic material a couple times a week can increase a woman's interest in sex, she says. While a gradual decline in testosterone levels can affect female libido, female testosterone levels do not always correlate with level of desire. Testosterone therapy for women can produce unwanted side effects if not closely monitored.

Viagra for Women?

And there is no Viagra® for women. “Viagra is a medication that increases blood flow to the genitals, which improves penile erection. But studies of Viagra in women are not convincing. Viagra is not a treatment for low desire,” says Dr. Gass. “Mental arousal and genital arousal are not the same thing. Women can feel mentally and emotionally aroused without genital arousal, so the two do not correlate well.”

There are no approved medications for sexual desire. The best resource for arousal is your brain, says Dr. Gass.

“Being on very pleasant terms with your partner and thinking sexual thoughts are two components for becoming aroused,” she says. “Make a mental list of what arouses you. If the cause of lack of enjoyment or desire is not apparent, you may want to see a sex therapist or marital therapist.”

Discontinuation of sexual intercourse may lead to vaginal stenosis (shrinking/tightening) and the inability to have intercourse, she notes.

“The human range of desire is very wide, and it’s rare to see a perfectly matched couple. Many couples have to compromise on sexual frequency and variety as they age,” she says. “Some couples take advantage of slowing down to enjoy intimacy even more.”

For more information on restoring your intimate relations during menopause, download our free Guide On Sexual Health During Menopause.

To see Dr. Gass or other physicians in Cleveland Clinic’s Center for Specialized Women’s Health, call 216.444.4HER. Visit us online at clevelandclinic.org/womenshealth.