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Summary
Definition of Menopause
Possitive Effects
Negative Effects
Cause of Problems
Effects of Ageing on Sexual Response
Treatments
References
EFFECTS OF AGEING AND MENOPAUSE
ON SEXUAL FUNCTION IN WOMEN
TREATMENTS
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Medical:
History and examination: to exclude physical and psychological causes of problems, and treat medical conditions such as diabetes, thyroid problems, high cholesterol, blood pressure and depression, and to adjust medication in type and timing of administration if possible.
Good lifestyle habits: exercise, diet low in fats, high in fibre, calcium and vitamin D, weight control, no smoking, minimal alcohol, reduced stress.
Improve body image: diet, exercise, hairstyle, clothes, personal hygiene.
Hormone replacement treatment [HRT]: it is unlikely that treatment with estrogen improves sexual desire, but it can restore well being after the menopause, improve sleep quality, and restore sensitivity to touch of the skin, and reduce vaginal dryness, all of which may improve desire and ability to be aroused.
The use of androgens [the male hormone testosterone] to treat low sexual desire is still controversial, but may be advised by your doctor, in particular after premature menopause, chemotherapy for cancer, or following surgical removal of both ovaries. Treatment may be indicated for lw sexual desire only if the patient's testosterone levels are low.Testosterone implants or injections may be advised, and this helps to improve libido and arousal [2].The safety of long term use of testosterone in women is still unclear, and there are side effects [facial hair and deepening voice] and it cannot therefore be recommended, and lasting effect of short term treatment is unproven. The testosterone patch may become available and may reduce adverse effects, but this remains to be tested. Your doctor may recommend a testosterone cream which can be applied to the clitoris and small lips around the entrance to the vagina.
Women who have had a hysterectomy can use estrogen replacement alone, but women who have not should use a combination of estrogen and progestogen. These treatments come in the form of pills, skin patches, vaginal creams or tablets, and injections or implants placed under the skin. Some women have an intra-uterine device containing the progestogen hormone, and take low doses of estrogen by mouth. HRT relieves many of the symptoms of menopause and prevents osteoporosis [thinning of the bones].
Generally women are advised to take HRT to treat unpleasant physical symptoms of the menopause for up to 5 years, but a lot depends on your own health and family history, so discuss this with your doctor. There are other effective medications available for the prevention of osteoporosis that can be prescribed if you are not able to take HRT.
Many women use non- prescription ‘natural’ medication, but there is no sound scientific basis that their use improves menopausal health or protects from osteoporosis, and they are not proven to be effective, risk free as they are not subject to controlled trials and drug licensing authorities.
Relationship therapy:
Counselling to deal withanger, rejection, performance anxiety, communication skills and re-establishment of intimacy [See: Relationship Therapy]. Be sure to spend leisure time in mutually enjoyable activities.
Sex Therapy:
Avoid monotony, introduce spontaneity, and variations of where and when you make love. Although sexual activity may be less frequent and less intense than in youth, it, can be more satisfying and less inhibited, so be spontaneous and adventurous, try new positions, oral sex, use a vibrator or masturbation. Guide your partner so that stimulation gains the maximum potential arousal for both of you. A person needs their partner’s response in order to initiate sexual activity, and if this does not occur, will usually not proceed.
VENIS [very erotic non-insertive sex] is especially helpful for elderly couples with physical disabilities [2]
Remember that making love does not have to include orgasm or intercourse.
Sexual assignments: self-pleasuring, sensate focus and genital stimulation [See: Sex Therapy]. Intercourse should always be preceded by caressing and should include direct genital stimulation. Oral and manual stimulation as part of foreplay may make the difference to arousal, and may be acceptable alternatives if intercourse is not possible.
Masturbation may be helpful in maintaining vaginal elasticity and lubrication, and would be an important option if your partner is ill or has an erection problem.
Positions: the side by side position is comfortable and reduces effort for older people with infirmities. The weight is on the bed, hands are free for caressing, and both partners can thrust as desired. Pillows can be used for support if necessary.
Avoid making love when fatigued, after excess food or alcohol [the usual "nightcap" may be "excess" at this age], or when under stress or in pain.
It is healthy for the social, emotional and physical well-being of older people that an active sex life be maintained as long as possible [3].
You can continue to enjoy caressing and intimacy throughout your lives, even if intercourse is limited by infirmity or ill health. Even though your patterns of response have altered you can give each other sexual pleasure and orgasms through activities that don’t need erections or penetration As with all basic appetites [food, sleep, exercise] that for sexual expression diminishes in urgency and intensity over the years, but the subjective enjoyment can be as intense as in youth.
It is far easier to maintain an active sex life than it is to re-awaken a long dormant one. The adage “use it or lose it” does apply here.
In your ‘golden years’ you no longer have the responsibilities of child rearing or daily constraints and stresses of work. It can be a wonderful time for emotional and physical intimacy. Try to become a ‘courting couple’!! –have fun. be as carefree as you were on honeymoon but less anxious!
