Health Topics

Sex After Menopause Is Possible and Encouraged!

By Margery Gass, M.D.

What is Female Sexual Dysfunction?

Female sexual dysfunction is more common than you might think. Several surveys show that approximately 43 percent of American women have some form of sexual dysfunction, from low desire to painful intercourse.

In postmenopausal women, several factors can contribute to a less-than-fulfilling sex life. Declining estrogen levels associated with menopause can lead to a decreased arousal. The testosterone so vital to the male libido is also present in women; the gradual decline in testosterone levels from age 30 onward may affect the female libido. And vaginal dryness - common in post-menopausal women - can make intercourse painful, not to mention all the stresses of midlife.

Before medical school, I helped organize a support group of mothers with young children who met to discuss medical topics of interest to women. I chose the topic of menopause and that turned out to be the turning point in my life. At nearly 30 years of age, I returned to school to obtain a medical degree. In those years, women were not really included in making decisions regarding their health care; the style then was for physicians to tell patients what to do. I saw entering the medical profession as a way to change healthcare to a more collaborative model.

Defining the Problem Leads to Solving it

The definition of sexual dysfunction is any aspect of your sexual function that causes you concern and distress. Sexual dysfunction can happen at any age. The causes are likely to be different at different ages.

Many things can cause problems in your sex life:

  • Certain medicines (such as oral contraceptives, high blood pressure medications and chemotherapy drugs)
  • Diseases (such as diabetes or high blood pressure)
  • Excessive alcohol use or vaginal infections
  • Depression
  • Antidepressant medications

It is common for both men and women to experience slower sexual response with aging. Fantasies and adding variety to the sexual repertoire (different positions, different locations, sex toys, vibrators) can be helpful. Some people take advantage of the slower response in both men and women to enjoy the intimacy even more.

Solutions can Involve Over-the-Counter Help

One of the symptoms of decreased sexual arousal in women is the reduced amount of vaginal lubrication. Over-the-counter vaginal lubricants can augment lubrication. If the decrease in vaginal lubrication resulted from menopause, vaginal estrogen therapy can help if lubricants and vaginal moisturizers are not enough. Estrogen is the only proven prescription drug therapy for this condition.

The best resource for arousal is our brain. Being on very pleasant terms with your partner and thinking sexual thoughts are two important components for getting aroused. Think about what you find arousing. Let your partner know when he/she does something or wears something that appeals to you (even if it was just a favor that person did for you). Make a mental list. How can those things be incorporated into your lovemaking? If thoughts and feelings are not enough, there are many lubricants and sex toys available to explore.

When Hormones Play a Role

Hormones play an important role in sexual function in women. With the decrease in the female hormone estrogen that is related to aging and menopause, many women experience some changes in sexual function as they age, including decreased vaginal lubrication and sometimes decreased genital sensation.

Research suggests that low levels of the male hormone testosterone may contribute to a decline in sexual arousal, genital sensation and orgasm. Researchers still are investigating the benefits and risks of the use of male hormones in women.

Estrogen is considered a hormone of desire. If lack of interest in sex is due to discomfort or dryness with intercourse, estrogen could improve comfort with intercourse and indirectly increase desire.

Staying Sexually Active After Menopause is Key

If a woman wants to maintain sexual function after menopause, it is important to continue sexual activity. Most women who continue sexual activity on a regular basis through the menopause transition do fine with sexual function without using any hormone therapy.

I believe every woman should enjoy a fully active sex life as long as they want one. If simple tips are not the solution for you, I encourage you to visit one of the caring professionals at the Center for Specialized Women’s Health.

An internationally recognized leader in the field of menopause, Margery Gass, MD, is the Executive Director of The North American Menopause Society (NAMS) and editor of the NAMS journal Menopause. Dr. Gass sees patients at Cleveland Clinic’s main campus at the Center for Specialized Women’s Health. For an appointment, call Cleveland Clinic4HER@ Women’s Health Line at 216.444.4HER.