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
WE ARE LOOKING FOR FEEDBACK REGARDING PAINFUL SEXUAL EXPERIENCES. TOTALLY ANONYMOUS. PLEASE CONSIDER OUR SURVEY www.ecophysio.com/survey
References:
- Dennerstein, L et al. 2001. Are changes in sexual functioning during midlife due to aging or menopause? Fertility and Sterility 76(3): 456-460.
- 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.
- Stronczak-Hogan, Irene. 2018. Hot Chixs, Hot Sex: How to Survive Menopause. Blackcard Books:
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