Wednesday, 10 October 2018

I just don’t feel like having sex-Peri/Post Menopause



Recently, several women have been coming into my clinic and saying, “I just don’t feel like having sex” or “I have no sex drive.” A few women indicated that if they never had sex again, it would be fine with them. While the other half expressed deep concern over their decreased libido and what this means for their life and relationships moving forward.

This is an area I haven’t explored in depth and I wanted to better understand what might be some factors impacting women’s libido. For this blog I will focus on the perimenopausal to postmenopausal phase.

Is a lack of sexual drive and desire an age thing or a hormonal thing?

One study of four hundred and thirty eight Australian women between the ages 45-55 that were still menstruating sought to find an answer- is it age or hormones- what they found in the study is that it is both. As these women aged, sexual responsiveness decreased (1). Sexual frequency and libido was significantly less for postmenopausal women suggesting a hormonal role and how decreased hormones can impact pain with intercourse (1). Hot flashes did not impact sexual experience directly but had other impacts on health quality of life, which indirectly impacts sexual functioning (1).

Another study looked at healthy women and wanted to see if hormones were influenced and/or changed during sexual arousal. What they found was that following an erotic stimulation, estrogen levels actually increased and correlated with better orgasm and less pain (2). Estrogen’s role in arousal is vaginal lubrication and vaso-congestion, which means swelling of tissues, i.e blood flow (2). In the transition to menopause, estrogen levels drop and women more commonly complain about dryness, thinning of the vaginal walls and blood flow changes which can lead to pain with intercourse. When it hurts to have sex, our motivation to have sex is going to be impacted.

Testosterone, is another hormone that is believed to impact arousal. In the healthy women’s study, testosterone correlated with multiple orgasms and the women reported greater mental excitement, genital wetness and tingling after watching the erotic video (2).

In a book called, Hot Chixs, Hot Sex: How to survive menopause, the author talks about testosterone as playing a role in sex drive and libido. She mentioned that women who are stressed generally have lower amounts of hormones, including testosterone and that women who had a hysterectomy and their ovaries removed will have fifty percent less testosterone (3).

Another hormone of interest is cortisol, which is a hormone produced by the adrenal glands, along with DHEA, which is a main building block for estrogen and testosterone (2, 3). In the study of healthy women, cortisol levels dropped after erotic arousal and were correlated with higher levels of genital arousal (2). The study also suggested that higher levels of cortisol prior to arousal may actually inhibit sexual function (2).

Is it only age and hormones that affect sex?

No. There are a number of other considerations to take into account when sex drive is low. 

Menopause is a time of transition and change. Our bodies are changing and so are other psychosocial factors, for example, whether we have a partner, are single or been with someone for a long time (1). The age and health of our partner and their sexual functioning (1), how we feel towards our partners and the level of sexual activity previously. Other factors include, employment satisfaction, social class, level of education, access to health providers, personality, negative attitudes towards self or partner and actual physical and mental health (1).

I mentioned previously that sexual desire can be impacted by higher levels of stress because it produces cortisol. Another aspect we need to consider is our daily stressors. Are we getting any down time, are we constantly running around such that we don’t have the energy later?  Are we eating well to fuel our body?

If sex is something important to you, speak with your family doctor and work with a specialized compounding pharmacy to find the right hormonal treatment for you. If you prefer a more natural approach then perhaps a Naturopathic Doctor that works with bio-identical hormones may be appropriate for you. If you are having painful intercourse, make sure to find a Pelvic Health Physiotherapist to work on the tissues and find ways to make sex more physically enjoyable. Lastly, don’t forget about a psychotherapist. They will help you identify any psychosocial factors that may be impacting your sexual drive or the obstacles to living a healthier lifestyle.

The Pelvic Health Lady

WE ARE LOOKING FOR FEEDBACK REGARDING PAINFUL SEXUAL EXPERIENCES. TOTALLY ANONYMOUS. PLEASE CONSIDER OUR SURVEY www.ecophysio.com/survey 

References:
  1.        Dennerstein, L et al. 2001. Are changes in sexual functioning during midlife due to aging or menopause? Fertility and Sterility 76(3): 456-460.
  2.          Van Anders, SM et al. 2009. Associations among physiological and subjective sexual response, sexual desire and salivary steroid hormones in healthy premenopausal women. J Sex Med 6:739-751.
  3.        Stronczak-Hogan, Irene. 2018. Hot Chixs, Hot Sex: How to Survive Menopause. Blackcard Books: