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Hi Dianne -
I'm not sure whether your concern is a decrease or an increase in libido. While some women view menopause as bringing the end of female sexuality others find that intimacy is enhanced. Here's some information from our encyclopedia that addresses common concerns. Will you let us know if this answers your questions, or if you need some additional information? We'd be happy to help. Pat
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Several years ago Judy Grant, a 52-year-old lawyer, realized she was no longer getting her period, her vagina was drier than usual, and sexual arousal was taking longer. She began to worry that her sex life would soon disappear.

She had heard that at menopause, women lose their interest in and ability to have sex. But since she started using a little artificial lubricant and adjusted her expectations, she's found she enjoys sex more than ever. She especially likes the extra time she and her husband spend stroking and cuddling before they try to reach orgasm.

Like Judy, many women fear that menopause signals the end of their sexual desirability and pleasure. This fear comes from stereotypes of the midlife and older woman as unattractive and asexual. In addition, loss of the ability to bear children may become confused with loss of sexual desirability.

The reality is that the need for and capacity to have satisfying sexual relationships does not disappear as a natural or irreversible part of aging in women or men. According to Paula Doress-Worters, co-author of The New Ourselves, Growing Older and The New Our Bodies, Ourselves, "there is no reason to think that women in midlife should necessarily have problems with sexuality."

Although menopause does bring physiologic changes that may slow down response time and affect sexual activity in a variety of ways, 70% to 80% of women do not experience a reduction in sexual activity or satisfaction. And for those who do, there are safe, effective solutions.

How you perceive and deal with the changes can have a significant impact on your sexual health and pleasure. Some women have a reawakening of sexual interest when they are no longer concerned about getting pregnant and adult or older children require less time and attention. However, there is tremendous individual variation in women's experiences.

Changes at Menopause That May Affect Sexuality

Physiologic changes at menopause can sometimes affect sexual activity and desire in some women. Changes may occur in lubrication, the vaginal walls, arousal, orgasm, and sex drive that make sex less comfortable and enjoyable.

Vaginal Dryness and Pain During Intercourse

The most common problem is vaginal dryness, although only about 20% of women experience it. The vaginal walls may also become thinner and less flexible. Itching, burning, and occasional pain and bleeding may occur during intercourse.

Over-the-counter water-based lubricants, such as Astroglide and KY jelly, can help with vaginal dryness. Do not use petroleum-based lubricants such as Vaseline. They weaken the latex in condoms and can cause vaginal infections. Vitamin E or moisturizers such as Replens can also help if used regularly.

If lubricants and moisturizers are not sufficient, vaginal estrogen cream, rings, or tablets are generally helpful.

Stimulation and Orgasm

Some women have fewer and less intense orgasms when they reach menopause. It may take more time and stimulation to become aroused. For all women, having intercourse or masturbating regularly can help increase sexual responsiveness and pleasure. They keep the muscles supporting the uterus, vagina, and bladder in shape and increase lubrication. Kegel exercises, contractions of the pelvic muscle near the vagina, can also help strengthen the vaginal muscles.

Sexual Desire

Loss of interest in sex, temporary or long-term, occurs in some women during and after menopause. Possible causes include the following:

* Fatigue
* Stress
* Illness
* Relationship problems
* Psychological issues
* Medication side effects
* Hormonal changes
* Discomfort from the physical changes of menopause

Relationship problems tend to be the cause of decreased sexual desire only when there have been ongoing difficulties in the relationship. These difficulties may be exacerbated by changes at menopause. If this is the case, consider seeing a therapist who specializes in sexuality.

If the problem is hormonal, estrogen may help. However, its effect is generally on the physical changes, such as vaginal dryness and pain during intercourse. No direct relationship has yet been found between estrogen levels and desire to have sex.

One study in particular published in the journal Menopause in September/October 2000, found no direct relationship between declining estrogen levels and desire to have sex. Rather, the researchers found that hormonal levels, health, and social changes associated with aging, and the mental and emotional effects of being recently menopausal probably work together to create changes in a woman's sexual desire. Longer-term studies are needed to determine whether reduced estrogen production affects a woman's sexual functioning as she gets farther from menopause.

A natural decrease in testosterone at menopause might play a role in sexual desire, although this remains unproven. Testosterone is available in pills, injections, and creams, but side effects are a major concern.
Increased Intimacy

The changes that take place in midlife can provide an opportunity to explore new and different sexual experiences. Men also go through changes, such as needing more time and stimulation to become aroused. The slower, more sensuous foreplay that often results is a welcome change for some women.

Increased focus on sensuality, intimacy, and communication can help a sexual relationship become more rewarding than ever. There are many ways of expressing your love besides intercourse:

* Hugging, cuddling, kissing
* Touching, stroking, massage, sensual baths
* Manual stimulation
* Oral sex

Sexual relationships after menopause can indeed be satisfying if you are able to adapt to the changes that occur.

RESOURCES:

National Institute on Aging
http://www.nih.gov/nia

The North American Menopause Society (NAMS)
http://www.menopause.org

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://sogc.medical.org/

Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm

January 18, 2010 - 6:23pm

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