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Postmenopausal sex problems

November 29th, 2009 | Posted in Sex and menopause, Sexual health | No Comments »

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:
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Sexual health after 40. Regular sex as a part of our life.

December 18th, 2007 | Posted in All about sex, Sex and menopause, Sexual health | No Comments »

Sex after 40Just as our perception about life changes as we grow older, the same applies to our feelings about sex.

When we are younger, especially during the period of our sexual awakening, we tend to be ruled by lust, and this tendency seems to carry on as we experience the joys of relationships and sex.

We may meet our prospective life partners during this period and amidst rivers of sexual intimacy and love, we plan for our futures and start raising our families.

“While sex may seem to be the most important thing in the world when you’re younger, our perceptions about it may change when a woman hits her 30s.

“She’s probably a few years into a committed relationship and has settled into a sexual routine of sorts. The first flush of sexual excitement has died and she may have a young family, one of the factors that tends to affect female sexual desire,” said Australian sex therapist and relationship counsellor Dr Rosie King.

She explained: “Humans tend to experience a phenomenon called skin hunger, a craving for skin-to-skin contact. This acts as a powerful motivator of sexual activity.

“For women with young children, this skin hunger is met by regular contact with the children. The same does not apply to men as they tend to not be as involved in the care of young children. As a result of this, their main avenue to fulfil skin hunger is still sex.’’

As to be expected, women with young families also tend to lack sleep and have to deal with privacy issues. “These factors have an inhibiting effect on sexual desire. The 30s would undoubtedly be the time when there is a great desire discrepancy between men and women,” Dr King said.

She added that many marriages are strained as a result of desire discrepancy. “Because a woman’s sexual desire is low, the wheels may fall off in the relationship. The relationship may become toxic as while he chases her, she withdraws from him.

“Indeed, parenting is probably the biggest challenge to a woman’s sexuality in her 30s and sets a tremendous challenge to many marriages,” she said.

In a couple in their 40s, the challenges differ. “This is the point when men tend to be career-focused while women are preoccupied with their growing families and careers. Because couples tend not to focus on their relationships, there is a danger that they will drift apart. There is often less time to talk, what more issues of affection and sex,” Dr King said.

She says that couples in their 40s should make time for sex at least once a week or fortnight – even if they don’t experience a high level of sexual desire.

“The sexual contact will be good for the marriage as the couple spends some intimate time together. There is a saying ‘If you don’t use it, you lose it’ and one should remember that regular sexual activity facilitates sexual functions,” she said, adding that medical conditions such as erectile dysfunction (ED) may also rear its ugly head when a man is in his 40s.

As a man hits his 50s, he may begin to question his masculinity as it is harder to achieve an erection, which at this stage of his life is less firm.

Indeed, his days of achieving a Grade 4 erection may be far behind him – at least without the aid of medical treatment.

“The Pfizer Global Better Sex Survey indicates that there is a strong association between erection hardness and sexual satisfaction, so this could be a fragile time for the relationship.

“While worrying about this, the man would also have to deal with less intense orgasms and a longer recovery period,” she said, adding that while a young man takes an average of 19 minutes before he is good to go again, a 55-year-old man may take anything from 24 hours to a week.

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For women, the 50s is a time when there may be changes in the balance of relationships. “Couples find themselves in an empty house while work pressures may increase.

“For some, life may be easier but this is usually the time when the impact of menopause is felt. This is hardly a pleasant situation and these women must have the patience and understanding support of their husbands,” Dr King said.

To keep the relationship on track – no matter what age bracket a couple falls into – it would be important to constantly communicate with each other.

“Communication is key if a couple hopes to remain close. It not only acts as a sexual enhancer for women but keeps the relationship strong as the couple talk about their greatest fears and desires,” Dr King said.

Sex After 35 - Why Its Different, Why It Can Be Better

As couples approach the middle years, our bodies, lifestyles and sexual responses change. Both men and women have physical, psychological and hormonal changes which are normal, gradual and subtle. The changes can even improve a couple’s sex life!

For women, some of the changes are caused by menopause, which occurs when female hormones decrease, bringing a halt to menstruation. On average, that happens in the early 50’s. But the process often begins in the early to mid-40’s and spans four or five years. During this premenopausal period, a woman’s vaginal tissues may become thinner, drier and slower to lubricate. She may lose protective fatty tissue in the pubic area while gaining weight elsewhere. Once pleasurable, intercourse may now feel uncomfortable, even painful.

Not understanding these natural physical changes, she may complain that her husband is being too rough and withdraw from sex. Her husband may mistakenly believe she has lost interest in him.

Men go through hormonal changes too. Testosterone, which influences a mans sex drive, reaches its peak between 20 and 30 and gradually decreases thereafter. A French study of 1408 healthy men ages 20 to 60 showed up to a 25 percent decline in testosterone over four decades. This is why products such as Natural Sex work for some since, they often result in more free testosterone in the body). Primarily as a result of reduced blood flow, a middle-aged mans erections are not as firm as when he was young.

However, none of these changes should interfere with a full sex life. For example, if a woman has vaginal discomfort, the solution may be as easy as a shift of position during intercourse or use of an inexpensive, over-the-counter water-soluble lubricant. A 40-year-old man’s softer erections don’t prevent him from reaching orgasm.

Indeed, experts say the changes themselves can actually enhance the relationship and make for better sex - if the couple discovers ways to capitalize on them. Here’s how to have the best sex after 35:

Reset the pace. “Sex in the young is fast and furious,” says Dr. Herant Katchadourian, professor of human biology at Stanford University. “It ignites and fizzles out like fireworks.” A man in his 20’s achieves orgasm within two to five minutes after intercourse begins; his female partner may take 20 minutes or more to reach her peak of excitement. “While she’s still warming up, it may be all over for him,” says marriage, family and child counselor Bernice Itkin of San Francisco.

But as a man ages, the tempo changes from allegro to largo. Because of a normal slowing of blood flow and changes in muscle tone, men in their 40s or 50s require more time to reach a climax, and their orgasms are less forceful.

Now a man’s timing more closely matches the woman’s. He may become more in tune with her interest in slow, sensuous seduction. With this kind of synchronization, it’s no coincidence that women respond enthusiastically. According to a 1994 University of Chicago study, women in their 20s are least likely of all age groups to achieve orgasm during intercourse. Women in their early 40s are most likely - and by a wide margin. By concentrating on how he is increasing his partner’s pleasure, a man can increase his pleasure as well.

Take action. “A young man can get an erection at he drop of a hat - or bra,” says Judith Seifer, president of the American Association of Sex Educators, Counselors and Therapists. But after 35, he may be turned on less by what he sees than by his partner’s kissing and caressing. The University of Chicago study found that 51 percent of 25-to-29- year-old men became excited when they watched their wives undress. By the mid- 40s, the percentage dropped to 40. Once couples learn to pay less attention to what they see and more to what they do, says New York City sex and marital therapist Shirley Zussman, their sex lives improve dramatically.

Balance the seesaw. When they were first married, the man remembered, he always took the sexual lead, pulling his wife close and whispering his desire to make love. But now, 20 years later, she often makes the first move.

Again, hormonal changes are bringing the couple into closer balance. Men and women both produce testosterone and estrogen, but the proportion of each changes over the years. The male’s shifting levels of estrogen and testosterone may make him more willing to follow than to lead, happy for his partner or wife to set the pace. And as a woman’s estrogen declines and her testosterone becomes proportionately greater, she may become more assertive.

Dare to experiment. As partners become older, more experienced and more trusting of each other, they may become less inhibited in their views of what constitutes satisfying sex. “When we were first married, I couldn’t have imagined myself saying ‘Touch me there,’” one woman says. “The scenario has changed now, but it’s not that we’re all that different. It’s that our relationship just got deeper.”

Says Zussman, “It’s a time for new ideas, or a new look at old ideas. “Cuddle up in front of a warm fire. She recalls one 40-ish couple seeking to put more zest into their relationship. “Do you ever shower together?” Zussman asked. The two looked at each other. “We used to,” the wife said sheepishly. “Try it again,” the therapist suggested. They did - and it worked.

“Intercourse isn’t everything,” Zussman says. “It’s like the old travel slogan: getting there is half the fun.”

Achieve more from less. The University of Chicago survey showed that nearly half of 25- to 29- year-olds said they made love at least two or three times a week, including 11 percent reporting four times or more. By the early 40s, the number had fallen to 30 percent. The largest proportion, 45 percent, reported sex “a few times per month” (possible due, in part, to fatigue and the demands of child-rearing). Yet more than any other group, men and women in their 40s considered themselves emotionally and physically satisfied by their lovemaking.

As the frequency drops, couples should realize that each encounter can become more special, a moment to be anticipated and savored. In a secure relationship, there is less emphasis on how often, and more on how good. “I find that people in their 40s or so remember this moment or that moment, whereas to the younger ones, it may be all a blur,” says Zussman. “When it’s no longer an everyday thing, it means more.”

A gratifying sex life after 35 calls for a series of adjustments. Some people confront them poorly: the 45-year-old male who skitters off after a 21-year-old cocktail waitress, the middle-aged woman who flirts to prove that her allure hasn’t faded. But for couples, who understand the normal and inevitable changes, and meet them together, sexual pleasure can be greater than ever. Their sex lives will be rich in their 40s, 50s - and far beyond.

Sex After Kids

Tending to small children is not a particularly romantic thing. Poopy diapers and vomit just don’t bring out the vixen in most women.

There’s no doubt about it, small (and sometimes large) children can put a damper on a woman’s sexual desire. The exhaustion factor is there quite often. There can be some resentment about the division of labor in the household. Hormonal changes can occur. Breastfeeding keeps prolactin in a woman’s body and that suppresses sexual desire.

The level of intimacy in the marriage generally goes up when children arrive. Sometimes that level is too high. All the issues that must be handled when children are part of the picture can overload a couple’s ability to be connected romantically.

I have found that most couples don’t begin to get back to anything that resembles their earlier sexual relationship until the youngest in the house is three. Until that time, most couples have less energy for sex. That’s the nature of raising little children if you’re doing the parenting instead of a nanny.

In my opinion, that’s where “dating” comes in. Pick a Saturday night for a date. Get a sitter. Make sure that you get a nap that afternoon (that’s your husband’s duty to assure). Then, go out for dinner and some time for emotional connection between you as adults. The sitter puts the baby to sleep and you come home as soon as the coast is clear. That’s your time to have some sex that isn’t hurried or sleepy.

Put those “dates” on the calendar as often as you feel is appropriate. Your husband then has at least that to anticipate. You feel less pressured on the other days. (Sometimes feeling less pressured leads to an occasional spontaneous sexual connection springing from general good will.)

Does great sex start at forty?

The news that has emerged from a global study, involving 30,000 people - that it is the over-40s in “gender-equal” countries who have the best sex - is, for those over 40 in such places, cheering, but not exactly news. We knew that. If it discomfits the young, and the institutionally chauvinistic, then, well, even better. Advertisers who peddle the notion that only the under-25s have any right to make the beast with two backs should also think again. Or simply think.

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Post-menopausal sexual dysfunction

December 12th, 2007 | Posted in All about sex, Sex and menopause, Sexual health | No Comments »

sex-after-menopauseEven the most sexual of women may find their thoughts turning away from intimate relations with their husbands when they have to deal with some of the symptoms of menopause.

Take Rita, 51, a woman who enjoyed a healthy sex life with her husband and liked what she saw when she looked into the mirror until she started experiencing the hot flushes, night sweats and mood swings that are symptomatic of menopause.

“How can you expect me to feel sexy and want to have sex when I’m uncomfortable all the time?” she complained constantly.

Rita is typical of many post-menopausal women in that her symptoms have had an effect on her quality of life as well as interest in sex.

Australian sex therapist and relationship counsellor Dr Rosie King said: “You can’t blame women for not feeling sexy at that point as they are likely to suffer from pain-in-the-neck symptoms such as mood swings, night sweats, hot flushes as well as insomnia.

“The drop in oestrogen levels can also affect the genitals as women experience a thinning of the lining of the vagina. As a result of this, the vagina may become dry and fragile, making sex painful,” she said.

Menopause does not have to translate to the end of a healthy sex life. “Women who take hormonal replacement therapy (HRT) can enjoy a better sex life. HRT is very effective in improving the health of the vagina and it increases lubrication as well,” said Dr King.

Sensitivity to your partner’s needs would increase a interest in sex. “Women need an average of 15 to 20 minutes to become aroused and older women need even more time. Her sexual responses slow down and her orgasm is less intense, but a man can help to increase her urge to merge.

“He should attempt to learn what turns her on. He should spend more time talking to her or hugging her. Buy her flowers and spend quality time with her. These are typical female sexual enhancers and may increase a woman’s interest in sex,” Dr King said.

Dr King added that other factors could affect an interest in sex in post-menopausal women.

“There is an association between depression and menopause, for instance. This could be related to the ‘‘empty nest’’ syndrome. This is usually the period in her life when the children have left home. All she has left is her husband.

“Many women become depressed as a result of the children growing up and going away and there is no doubt that depression is an inhibitor of sexual response,’’ she said, adding that treatment for depression also tends to inhibit sexual desire and arousal.

Ignorance can also be a factor in female sexual dysfunction in menopausal women, Dr King said. “Some women don’t understand what’s happening to their bodies and that it is a natural part of ageing. They blame themselves or their partners for what is happening. This, of course, tends to affect sexual function,” she said.

To prevent this from happening, Dr King recommends that women seek treatment. “Menopause is a time of great transition for women and it is crucial that they seek treatment if they exhibit symptoms. Be aware that help is available,” she said.

She added: “Husbands need to be patient and understanding even if their wives are irritable and forgetful. While he may never understand what his wife is going through, he should realise that these are the effects of the hormonal transition that his wife is experiencing.’’

Worrying about one’s sexual performance tends to be a factor for pre-menopausal and menopausal women.

The Pfizer Global Better Sex Survey (GBSS) indicates that 48% of Malaysian women aged between 45 and 54 and 22% of women aged between 55 and 64 worry about losing their ability to perform sexually as they and their partners grow older.

While their fears may be justified, Dr King is quick to point out that menopause doesn’t necessarily have to be a traumatic experience.

“For some women, it’s a liberating experience as they have said goodbye to period pain and worries about contraception. The good news is that some women actually enjoy sex more because they feel totally free of these worries,” she said.

Is There Sex After Menopause?

Symptoms of Menopause

  • absence of menstruation for one year
  • hot flashes
  • night sweats
  • mood swings
  • anxiety
  • palpitations
  • depression
  • insomnia
  • vaginal dryness
  • urinary changes

Sexual Desire and Menopause
Does menopause mean that sex is no longer an important or desired part of life? No! Countless numbers of both genders believe that menopause means less sexual desire; however, that is not neccessarily true. In fact, sex after menopause is often as enjoyable, sometimes even more enjoyable than before menopause. Since you no longer face any threat of pregnancy and your children have grown up, or at least are almost grown, you and your spouse are finally alone for what is, many times, the first time since you married. So, go ahead and enjoy your opportunity to have the best sex of your life!

Yes, it’s true that getting older, often means it takes a little longer to feel sexually aroused, and it’s quite normal to experience a small decrease in sexual desire as part of the aging process. But growing older doesn’t mean that your sex life is over.

If you have experienced a loss of sexual desire since menopause, before you decide that menopause or just getting older is responsible for your lowered libido, consider a few other possible causes.

Many medications such as anti-hypertensive medications, tranquilizers, and antidepressants can change how you feel about sex. Other issues that affect sexual response include diseases such as heart disease, diabetes, and arthritis, as well as your self-image and the amount of stress you must deal with on a daily basis.

Is Reduced Estrogen After Menopause the Culprit Behind Lowered Sexual Desire?

Researchers at the New England Research Institute and the University of Massachusetts Medical School have discovered an amazing fact. While many of us naturally assume that the drop in estrogen production experienced during menopause is responsible for the postmenopausal decrease in sexual desire often experienced by postmenopausal women, the fact is that key factors influencing who has sexual issues include individual attitudes towards sexuality, overall health and marital status play a significant role in determining who experiences sexual issues during menopause and that estrogen is not related to changes in sexual response in postmenopausal women. Researchers found only one issue related to decreased estrogen production during menopause – painful sexual intercourse.

What You Believe About Sex and Menopause is What You Get?
A key finding, by the researchers, is that the only women to experience loss of sexual desire during the postmenopausal period, were only those women who believed that loss of interest in sex is a normal part of the aging process.

Does Postmenopausal Testosterone Supplementation Increase Sexual Desire?
Many women are able to increase lost sexual desire using prescribed testosterone during menopause. The benefits of testosterone include increased relief of the vasomotor symptoms of menopause, i.e. hot flashes and night sweats; increased energy; a general feeling of well-being; and increased sexual desire.

While some evidence exists that supplementing with testosterone during menopause may increase sexual response in postmenopausal women, there are certain health risks and potential side effects associated with testosterone supplements in women (the female reproductive system naturally produces small amounts of testosterone.) One study presented in the Archives of Internal Medicine and based on more results from the Women’s Health Initiative shows that women, in the study, who used both estrogen and testosterone during menopause experience a 17.2 percent increase in breast cancer risk for each year of use. Women who used either estrogen alone or estrogen with progestins did not observe this increase.

Each women should weigh the potential risks against the benefits of hormone replacement therapy including the use of testosterone supplementation with her health care provider so that, together, you can reach an informed decision about what is right for you.

Two Points to Remember about Sexual Response and Menopause

  • Loss of sexual response or desire is not experienced by the majority of menopausal women.
  • Loss of sexual desire is not associated with decreased levels of estrogen.

Men Have Viagra… What About Us?
Will there ever be a Viagra for women? According to a New York Times report, a Viagra for women is already under development. However, this drug may take several years before it becomes available for women who suffer from menopausal decreased sexual desire.

If you experience decreased sexual desire after menopause, see your health care provider for information about your treatment options. Also, make sure to talk to your partner so he’s aware of your feelings and sexual needs.

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