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11 Jan 2003

Post-menopausal loss of libido
I am a very fit, slim and attractive 52 year old, who, prior to menoopause enjoyed a fantastic sex-life. During the last two years, however, I have found it quite difficult to become aroused and achieve orgasm, but, not only that, I am almost at the stage where I don't even want to have sex. My body has become insensitive. This is frustrating and intensly annoying, as I have always really enjoyed sex. Is there any solution? I am taking HRT.
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Expert
Sexologist
sexy

01 Jan 0001

Menopause and the 5 to 10 years leading up to it, called perimenopause, can cause physical changes that may present new challenges to your lovemaking. Oestrogen, made by your ovaries, declines gradually during perimenopause, then drops off precipitously at menopause. As a result you may experience:
* Vaginal changes. The opening to your vagina becomes narrower, especially if you're not sexually active. Lubrication occurs more slowly during arousal. Even when you feel sexually aroused, your vagina may stay tight and dry. These factors can lead to difficult or painful intercourse, called dyspareunia (DIS-puh-ROO-ne-uh).
* Diminished or slowed response. Blood flow to your genitals lessens, increasing the time for your tissues to swell with blood (engorge) during arousal. You can have an orgasm throughout your life, yet your response may be slower or less intense.
* Changes in sensitivity. Thinning and shrinking of vaginal tissue expose more of your clitoris. Greater exposure may reduce your sensitivity or cause an unpleasant tingling or prickling sensation when touched.
* Higher risk of infections. Thinning of vaginal tissue increases susceptibility of the tissue to damage and infection. Your vaginal area also becomes less acidic, making yeast or bacterial infection more likely.
* Stress incontinence. Oestrogen deficiency reduces support to your urethral sphincter, the muscle that controls urine flow, and to your urethra, the tube that carries urine from your bladder. With the increase in abdominal pressure that occurs during intercourse, you may leak urine.

Will you lose your desire?
If you're like most women, your desire for sex probably won't change. Sexual desire results from a complex interplay between your unique psychological makeup, social and cultural conditioning, and hormones.

Although oestrogen affects sexual desire, the male sex hormone testosterone, made in small amounts by your adrenal glands, exerts greater influence. Testosterone levels decline after menopause, but not as much as estrogen levels do.

A greater proportion of testosterone to oestrogen after menopause may lead to an increase in your sexual desire. Anticipation of more time with your partner or having more time for intimacy also may boost desire. However, if intercourse becomes painful, or if you're bothered by symptoms of menopause, such as hot flashes, insomnia or irritability, your desire may wane.

Enhancing sexual desire and pleasure
Whether you want to keep the sizzle in your sex life or add spark to a flagging relationship, these suggestions may help:
Stay sexually active. Regular sexual activity improves vaginal lubrication and elasticity after estrogen levels decline. This regular sexual activity can include self-stimulation.

If vaginal dryness persists, try using a water-based lubricating cream designed for genital use, such as K-Y Jelly or Astroglide. Also, ask your doctor about a prescription estrogen-based cream, vaginal ring or vaginal tablet, which when used regularly helps alleviate dryness and thinning of vaginal tissue.

Develop a positive attitude toward sex. Your attitude and expectations about sex after menopause may have more to do with your sexual satisfaction than with your declining hormone levels. Tossing away the stereotype that a woman in her midlife is an asexual one may free you to become vital and sensuous.

Evaluate your priorities. Something as important as your relationship with your partner deserves high ranking on your list of must dos. Don't let your home or career responsibilities infringe upon the time you spend with each other. Relationships can provide meaning and satisfaction in life.

Be explicit about your desires. Tell your partner exactly what you want. If you become sexually aroused when spoken to or touched in a certain way, say so. Or if it's easier, guide your partner's caresses over your most sensitive areas.

Change the script. Many couples who've been together for years get in a rut. If your sexual script has been to spend 2 minutes on foreplay, then assume the missionary position and have intercourse, perhaps you can try something more playful and less predictable.

Talk about what each of you finds sexy. Remind each other that your intimate life together is much more than just sexual intercourse. Then go ahead, experiment with new, more exciting ways to please each other and prolong each sexual experience.

Touch each other in places you haven't explored before. Take turns massaging each other with warmed scented oils. Read erotic passages to each other. And when you have intercourse, be creative with position and location.

Consider hormone replacement therapy (HRT). This therapy, which provides a low dose of estrogen, often in combination with progestin, has been shown to be effective in treating many of the symptoms of menopause, such as hot flashes, vaginal dryness and discomfort with intercourse. HRT may be taken in a variety of forms — including pill, patch, cream or vaginal ring — and customized to fit each woman's needs.

But not all effects of HRT are positive. HRT may increase your risk of blood clots and gallbladder and heart diseases. And taking HRT as a combination therapy for several years or more may increase your risk of breast cancer. All combination HRT regimens can cause irregular vaginal bleeding, particularly during the first year of use. Further study is needed to determine to what extent estrogen-only therapy increases your risk of breast cancer.

How talking helps
For many women, emotional intimacy is an essential prelude to sexual intimacy. Talking regularly and openly about your feelings with your partner helps you reconnect and discover each other again.

If intercourse becomes painful or your desire fades, you may become angry or feel alienated. Rather than endure intercourse or reject sexual advances, try talking about your concerns during a nonsexual moment in neutral territory. A long, relaxing car ride or quiet dinner may offer just the environment for frank discussions.

At all costs, avoid prolonged silence. Repressed feelings, especially anger, can be hazardous to your well-being and long-term health. You may find it helpful to discuss your problems with your doctor or a counselor.

Taking care of yourself
It's difficult to have satisfying sex when you don't have a healthy self-image. To increase your energy and preserve confidence in your sexuality:
* Avoid excessive amounts of alcohol and don't smoke.
* Eat a healthy diet.
* Exercise daily.

Control stress and regain your sense of self by setting limits on demands from grown children and aging parents.
Getting better with age
Now that you're older, you're probably more in touch with your feelings and comfortable with your body. You and your partner may be more caring, nurturing and patient — perhaps even more daring. Yes, there will be changes. But knowing what you can expect and talking frankly about sex can free you to discover a deeper, more satisfying intimacy.

Good Luck
Dr Elna Mcintosh
The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical examination, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.
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