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.
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For other women, menopause brings declining desire or uncomfortable intercourse — leaving them and 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.
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 three most common causes — hormonal changes, health issues and lack of desire — are treated in different ways.
Problem #1: Painful intercourse
The most common symptom women notice at menopause is a decrease in lubrication, which can make intercourse painful. Lubricants, moisturizers or vaginal estrogen can help.
“Vaginal estrogen therapy is the only approved prescription drug therapy for this condition. It effectively restores the vaginal mucosa to a premenopausal state,” Dr. Gass says. “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, Dr. Gass advises.
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 have less sexual activity if they are overweight or have poor-to-fair health, arthritis or a history of heart attack. Diabetes, high blood pressure, excessive alcohol use, stress and fatigue can also cause sexual dysfunction.
“Older women need to stay fit to maintain their sexual functionality. This means avoiding excess weight, controlling cholesterol and preventing or managing diabetes,” Dr. Gass says.
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.
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, ask 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. Stress, fatigue, relationship issues and sexual boredom are common factors.
Although 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.
And there is no Viagra® for women.
“Studies of Viagra in women are not convincing,” Dr. Gass says. “Viagra is not a treatment for low desire. 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, Dr. Gass says.
“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.”
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.