Postmenopausal sex problems
It’s a common complaint of some postmenopausal women - painful sexual intercourse. The condition is medically known as dyspareunia and it’s no fun at all.
Doctors often attribute the problem to declining estrogen levels, which can lead to changes in the genital tract, including vaginal atrophy. The usual treatment is hormone replacement therapy, which can be applied directly to the sensitive region or taken in pill form.
But McGill University researchers have found that a significant number of women - up to 20 per cent - don’t respond to hormone therapy and they are seldom offered other treatments.
“Pain during intercourse can affect your relations with your partner, your image as a woman, your mood, all sorts of things,” said Irv Binik, director of the sex and couple therapy service at McGill University Health Centre in Montreal.
He said it is a mistake for doctors to assume all cases of painful intercourse after menopause are linked to the reduction in female hormone levels that occur with normal aging.
“It just isn’t that simple for a lot of women,” said Dr. Binik, senior author of the study that will be published in the journal Pain Research and Management.
Lots of other factors, including problems with pelvic floor muscles, dermatological conditions and infections, can make sex an unpleasant experience, according to Alina Kao, a PhD student who led the research project.
That also means there are a variety of different treatments - from physical therapy to traditional pain management - depending on the underlying cause.
However, Dr. Binik cautioned that these options are not usually quick fixes. “All of them take time and effort,” he said. “It’s not like popping a pill or putting on a cream.”
Myths About Postmenopausal Pain During Sex Shattered
Using hormone replacement therapy to alleviate painful sexual intercourse in post-menopausal women is not effective for a significant proportion of sufferers, according to a review study by McGill doctoral candidate Alina Kao, a student of Professor Irv Binik’s Laboratory for the Biopsychosocial Study of Sexuality. “This often-prescribed hormone replacement therapy (HRT) has mainly been studied in women who suffer from vaginal atrophy, a condition caused by declining estrogen levels, and changes in the genitals,” Kao said.
Although postmenopausal dyspareunia is a widespread problem which seriously affects a woman’s quality of life, Kao’s research team found that little is known about women’s primary complaint: pain.
Traditionally, postmenopausal dyspareunia has been attributed to declining estrogen levels and the changes this decline causes in the genital tract. Postmenopausal women have been prescribed hormonal replacement therapy to alleviate this problem.
Roughly one in three postmenopausal women suffer from dyspareunia, Kao said.
In questioning the effectiveness of HRT, Kao’s team found the therapy is not effective for a substantial proportion (10 – 27 per cent) of women. There may also be factors other than declining estrogen involved and these should be considered in future studies, the researchers concluded.
Although the use of a lubricant does help to decrease friction during intercourse, it generally does not alleviate the pain of dyspareunia, Kao said. This is likely because pain is often caused by factors other than lack of lubrication.
“In looking at the evidence, it seems there are numerous types of conditions that cause pain during intercourse in postmenopausal women, such as infections, dermatological conditions, problems with the pelvic floor muscles and chronic vulvar pain syndromes, to name a few,” Kao said. “However, these conditions are being overlooked by most treatment guidelines and healthcare providers,” she said. “Women shouldn’t have to ‘live with their pain;’ they deserve appropriate treatment geared to the causes of their individual pain conditions.”
Kao and her research team are conducting a multidisciplinary investigation, based on the emerging findings of this review, to classify the different factors associated with pain during intercourse in postmenopausal women. Women who take part in this research receive comprehensive medical and psychosocial evaluations of the causes and effect of their dyspareunia, as well as individualized treatment recommendations and referrals.
How Does Menopause Affect Sex Drive?
The loss of estrogen following menopause can lead to changes in a woman’s sexual drive and functioning. Menopausal and postmenopausal women may notice that they are not as easily aroused, and may be less sensitive to touching and stroking — which can result in decreased interest in sex.
In addition, lower levels of estrogen can cause a decrease in blood supply to the vagina. This decreased blood flow can affect vaginal lubrication, causing the vagina to be too dry for comfortable intercourse.
A lower estrogen level is not the only culprit behind a decreased libido; there are numerous other factors that may influence a woman’s interest in sexual activity during menopause and after. These include:
Does Menopause Lower Sex Drive in all Women?
No. In fact, some post-menopausal women report an increase in sex drive. This may be due to decreased anxiety associated with a fear of pregnancy. In addition, many post-menopausal women often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners.
What Can I Do to Treat Vaginal Dryness During Menopause?
During and after menopause, vaginal dryness can be treated with water-soluble lubricants such as Astroglide or K-Y Jelly. Do not use non-water soluble lubricants such as Vaseline because they can weaken latex (the material used to make condoms, which should continue to be used to avoid pregnancy until your doctor verifies you are not producing anymore eggs and to prevent contracting sexually transmitted diseases). Non-water soluble lubricants can also provide a medium for bacterial growth, particularly in a person whose immune system has been weakened by chemotherapy.
How Can I Improve My Sex Drive During and After Menopause?
Currently, there are not any good drugs to treat sexual problems in women dealing with menopause. Estrogen replacement may work, but research has yielded conflicting results regarding its effectiveness. Estrogen can, however, make intercourse less painful by treating vaginal dryness.
Doctors are also studying whether a combination of estrogen and the male hormones, called androgens, may be helpful in increasing sex drive in women.
Although sexual problems can be difficult to discuss, talk to your doctor; there are options to consider, such as counseling. Your doctor may refer you and your partner to a health professional who specializes in sexual dysfunction. The therapist may advise sexual counseling on an individual basis, with your partner or in a support group. This type of counseling can be very successful, even when it is done on a short-term basis.
How Can I Increase Intimacy With My Partner During Menopause?
During menopause, if your sex drive isn’t what it once was but you don’t think you need counseling, you should still take time for intimacy with your partner. Being intimate does not require having intercourse — love and affection can be expressed in many ways. Enjoy your time together — you can take long romantic walks, have candlelit dinners, or give each other back rubs.
To improve your physical intimacy, you may want to try the following approaches:
Educate yourself about your anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and responses. This may help you overcome your anxieties about sexual function and performance.
Enhance stimulation through the use of erotic materials (videos or books), masturbation, and changes to sexual routines.
Use distraction techniques to increase relaxation and eliminate anxiety. These can include erotic or non-erotic fantasies; exercises with intercourse; and music, videos, or television.
Practice non-coital behaviors (physically stimulating activity that does not include intercourse), such as sensual massage. These activities can be used to promote comfort and increase communication between you and your partner.
Minimize any pain you may be experiencing by using sexual positions that allow you to control the depth of penetration. You may also want to take a warm bath before intercourse to help you relax, and use vaginal lubricants to help reduce pain caused by friction.
Do I Still Have to Worry About Sexually Transmitted Diseases?
Yes. Just as you must use protection if you do not want to become pregnant during perimenopause, you must also take measures to protect yourself against sexually transmitted diseases (STDs) during menopause and postmenopause. It’s important to remember that your risk of contracting STDs is a possibility at any point in your life during which you are sexually active, and this risk does not go down with age or with changes in your reproductive system.
Left untreated, some STDs can lead to serious illnesses, while others, like AIDS, cannot be cured and are deadly.
How Can I Protect Myself From STDs?
Here are some basic steps that you can take to help protect yourself from STDs:
Sources:
http://www.sciencedaily.com
http://www.webmd.com
http://www.theglobeandmail.com