Every woman's experience of menopause is different. While some women have an increase in their sex drive, many report a decreased interest in intercourse. There are many reasons women tend to lose interest in sex after menopause, including hormonal changes and physical changes that can make sex uncomfortable or even painful. Despite this, it's still possible to enjoy a healthy sex life long past menopause. 

GSM and Sex After Menopause

Genitourinary syndrome of menopause (GSM) is a collective name that refers to the urinary tract and vaginal problems women experience when they are going through menopause or are postmenopausal. GSM symptoms can include pain during sex, bladder control issues, the urgency to urinate and a lack of lubrication. Researchers recently examined the prevalence of GSM and how it affects the ability of women to enjoy sex. 

Dr. Amanda Clark and a team of researchers surveyed over 1,500 women over the age of 55 between March and October 2015. Most of the women were white and 48 percent reported no sexual activity in the six months leading up to the study. The results of the study were presented at the North American Menopause Society (NAMS) annual meeting.

Within two weeks of a visit to a gynecologist or primary care doctor, the researchers approached the women after selecting them as participants using digital health records. The survey asked women about their history of urinary, sexual and vulvovaginal symptoms. The questionnaire was compiled for the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire with questions the researchers specifically designed. 

Why Many Women Avoid Sex After Menopause

Why Women Avoid Sex After MenopauseThe most common self-reported reasons women were not sexually active were a lack of a partner (47 percent) or a partner's lack of physical ability or interest (55 percent). 

Many participants also reported medical reasons. Frequent urination, the urgency to urinate and bladder leaks were reported by 7 percent of women. Twenty-six percent of women said sexual inactivity was caused by irritation, dryness or pain. Dyspareunia, or pain during intercourse, was listed as the main reason by 24 percent of women. 

The women who were sexually active reported discomfort or pain during sex. Forty-five percent of these women said the pain was always or usually present. Seven percent of these women also reported urine leakage during sex. 

Sixty-four percent of women who did not use a lubricant reported vaginal dryness. This is one of the most common menopause symptoms women experience and it can occur suddenly at any stage of menopause. Over half of all post-menopausal women between 51 and 60 experience vaginal dryness. About 17 percent of women between 18 and 50 also report vaginal dryness during sex, even before menopause. 

The study found that fear of pain is a more common reason (20 percent) for women to avoid or restrict sex following menopause than fear of bladder symptoms (9 percent). Dr. Clark underscored the importance of expanding a woman's sexual history when she reports she is not sexually active, adding that the findings are just another reason for doctors to have an open discussion with menopausal women to ensure all appropriate treatment options are considered. 

Hormones and Sex Drive

Sexual desire often wanes with age. Around the late 40s and 50s, many women begin to experience a reduced sex drive. While physical symptoms of menopause can undermine sex drive, hormonal changes also play a role. During menopause, the body stops producing estrogen. Testosterone levels also decrease in women around midlife. 

During menopause, the hormones that regulate sex drive, reproduction, mood and more begin to ebb, and these declining levels can negatively impact sexual function and desire. Hormones act as messengers in the body to control a vast array of functions. Three hormones are believed to affect female sexuality to some degree:

  • Estrogen: The main female hormone regulates the menstrual cycle, female sex organ development and the lining of the uterus. During perimenopause, estrogen levels begin to drop dramatically. Menopause occurs when estrogen levels are too low for the uterine lining to thicken.
  • Testosterone: Women have natural testosterone levels. This hormone is produced by the ovaries to help make estrogen. Testosterone declines naturally with age, especially after menopause. Some studies have suggested higher testosterone levels are associated with greater sexual behavior and desire in women.
  • Progesterone: This female hormone supports pregnancy and controls the menstrual cycle along with estrogen. As with estrogen, progesterone levels decline during menopause. It's believed changing progesterone levels impact female sexual behavior.

Maintaining a Healthy Sex Life Past Menopause

Why Women Avoid Sex After Menopause 1There are many ways to treat and control the symptoms that negatively impact sexual health after menopause. To counteract the decline in hormones after menopause, many physicians prescribe hormone therapy. Sometimes small doses of testosterone are also prescribed off-label along with standard hormone therapy to improve libido. Estrogen creams are a solution when vaginal issues are the primary problem. Topical or local hormone treatments do not carry the same risks as systemic hormone delivery. Estrogen cream can treat burning, dryness and urgency as well as irritation with urination. Certain natural supplements may also offer support for maintaining healthy hormone balance during and after menopause.

Lifestyle changes can also help address symptoms. 

  • Lose weight: The greater the amount of body fat, the less free-floating testosterone in the body. Losing 10 percent of your body weight can dramatically improve many areas of your life, including your libido.
  • Exercise: Several studies have found that blood flow to the genitals increases after just 20 minutes of exercise. This results in greater lubrication and arousal and better orgasms.
  • Use a lubricant: Lubrication is an easy and effective way to make sex more enjoyable if dryness is an issue. Don't assume all lubricant is medical-grade and sticky; most lubricants today are water-based and feel natural.

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