Sex in Menopause

Female sexual dysfunction is in the top five complaints of menopausal women. It is something I hear about on a daily basis in my practice.

Sexual function is something that everyone wants to know about yet women don’t feel very comfortable talking about.

I want you to get informed on this topic so you understand what is happening and get some help so you can rekindle your love life and reconnect with yourself and your partner this month.

The definition of menopause is not having a menstrual cycle for more than one year.

Menopause is a big deal. It is not a disease and it is not life threatening but it is a game changer. It is a physiology change.

When our physiology changes, we feel like we don’t live in the same body anymore. We feel displaced.

This happens in menopause. This happens with sex in menopause. Sexual sensitivity changes, desire changes, orgasmic ability changes. And for many women this is disheartening, we start feeling guilty, it affects relationships, body image and ultimately happiness.

I had a patient say to me “God took it (meaning the sex drive) away from me. I didn’t appreciate it for all those years that it was here and now it’s gone. I have no desire at all. Plus, it’s so painful and the coconut oil just doesn’t cut it.”

Some women experience dryness and irritation soon after the onset of menopause but others don’t experience symptoms until 5-10 years after their periods stop. Over time the loss of estrogen will cause the tissue to thin and shrink causing micro-tears. This causes an increased susceptibility to vaginal and urinary tract infections, and painful intercourse.

I often hear, “I’m done with menopause. I don’t have hot-flashes anymore.”

That’s what you think sister. You’re not done, you just entered the Queendom of menopause. You are going to be there for quite some time. Just because you no longer have hot-flashes doesn’t mean your boat has navigated out of the storm.

Are your hormones going to come back? Will you become fertile again in the next 10-20 years? Your fertile years are behind you. They are gone. Goodbye menstrual cycles, goodbye fertility, goodbye regular pap-smears.

What’s in front of you? Menopause, Menopausal body, Menopausal risk factors, Menopausal metabolism.

New Rules/New Game

The best thing you can do for yourself is learn all about the new menopausal body you have and how to live gracefully with it. A whole set of rules apply, new exercise requirements, new food requirements, new hormonal requirements, new sleep requirements, new hair & skin care products.

The way you used to have sex is a thing of the past. The new rules require a new understanding of your body so that you can have a healthy sex life in Menopause.

Hormones rule women. Hormones affect our moods, and the way we relate to life. Hormones affect your hair, skin, nails, joints, heart, bones, brain and on and on you get the picture. Each one of these lends itself to an independent discussion.

Sex shouldn’t hurt. Sex is a healthy activity. It’s good to have sex.

Sex is good for relationships. It makes you happier. Having sex decreases stress and it enhances the health of your vagina and sexual organs. There is a magical hormone that is released from a woman’s brain in response to intimacy. It’s called Oxytocin.  Oxytocin lowers stress and helps us to relax in a much deeper way. When we have Oxytocin, we become less critical of ourselves and others, we feel satisfied from within and have more to give. Oxytocin makes us feel loved and safe and cared for. Oxytocin is released every time you orgasm. Think of that post orgasmic bliss you once experienced, your body was awash in oxytocin.

Here are the Three main conditions that I hear women express concern about on a daily basis:

1. Loss of sexual desire/Loss of sexual arousal – no libido or low libido
2. Dyspareunia – painful intercourse
3. Orgasmic disorder – Inability to achieve orgasm or it taking a very long time.

Lack of interest is the most common complaint that women have.

Cancer Thrivers

Research shows that 83% of women report sexual problems after having a gynecologic cancer such as endometrial or cervical and 90% of women report sexual problems after having breast cancer.

Sexual Dysfunction that occurs in and around menopause is lumped into the category of Pelvic floor disorders.

When you sit cross-legged on the floor there is an entire network of muscles that work to stabilize your internal organs, this is called the Pelvic bowl. Your pelvic muscles work hard to keep everything in place and make sure nothing falls out under a constant gravitational pull.

In menopause, hormonal changes affect the tissues of the pelvic bowl. Combine this with laxity of back, pelvic, and abdominal muscles and we start to see things like:  Organ Prolapse and Urinary Incontinence.

There are other conditions that affect women of menopausal age that target the vagina, labia, and clitoris such as Vulvodynia, Vestibulodynia, Chronic Urinary and Vaginal Infections, Lichen sclerosis, Lichen planus and inflammatory skin conditions.

Lifestyle Affects Sexual Function:

Decreased sexual function has been noted with Depression and Anti-Depressant use. SSRI drugs, Diabetes, Insomnia, Obesity

A Healthier Lifestyle Promotes Sexual Function:

Regular exercise, whole-food Mediterranean based diet, Fresh fruits, social support, and having a normal BMI.

The decreased sexual function in menopause is related to hormones. And that’s what I want to talk more about now. Essential hormones such as Estrogen, Progesterone, Testosterone, and DHEA are critical for healthy sexual function. Hormones affect your brain chemistry. Brain chemicals called neurotransmitters such as nor-epinephrine, dopamine, and epinephrine influence your sexual function.

This is the premise behind prescribing menopausal women anti-depressants and the science behind the most recent drug release of FDA approved Addyi – Neurotransmitter boosting drug to increase sexual desire. There have been side effects reported of dizziness, fatigue, interacting with alcohol, and other medications.

That’s the problem with prescription medications and non-bioidentical hormones they are synthetic and foreign to your body and cause side effects.

The reason I specialize in natural medicine is because the natural approach serves up all the benefits of symptom relief and good health without the negative side-effects.

Many of you have experienced this with your partners who may be on blood pressure lowering medications. Blood pressure medications cause erectile dysfunction, and difficulty reaching orgasm. This can be bad news for you if you have vaginal dryness because intercourse takes longer and there is more friction which equals more pain for you.

It’s not just you, your partner is going through body changes as well. It takes good communication and some laughter to work through it successfully.

If you had a good sex life before menopause but now you don’t, the two most common complaints are lack of desire and pain.

Are you not in the mood because you think it will hurt? Pain is the fastest way to get out of the mood. So why are you in pain? Most likely because your vaginal tissue has thinned out and is less lubricated. It’s called vaginal dryness.

The main cause of vaginal dryness comes from lack of Estrogen.

The main cause of lack of desire is from low DHEA and Testosterone.

Estrogen keeps your vaginal tissue juicy and plump. Less estrogen, less lubrication, and thinner skin. Ouch!

There are a number of hormonal and non-hormonal options for Vaginal dryness:

HORMONES

If a hormonal option is necessary I use bio-identical hormone preparations. These are the exact match of the hormones that your body once produced. They are prescribed through a compounding pharmacy in the exact dose that you need and have little to no side effects. Bio-Identical hormones are not FDA approved because they are not patented drugs.

Conventionally trained Gynecologists prescribe The FDA approved drugs for female sexual dysfunction. Conjugated equine estrogen, Premarin vaginal cream, or Estrace. Premarin is synthetic and has been shown to cause breast cancer, and heart disease.

Most of the women I see prefer to avoid using any synthetic hormones that are linked to other health conditions. If you are a cancer thriver you may not want to or be able to use hormonal options.

Vaginal Dryness – Hormonal Options – If your vaginal tissue is very thin and your vaginal tissue is extremely sensitive and sex is painful, you may need to use hormones for a period of time in order to get you back on the right track.  You will need to work with a doctor who can properly test, and prescribe hormones for you.

• Estriol – topically on labia or intravaginal – hormonal – weaker estrogen
• Estradiol – topically Commonly prescribed by conventional doctors (estrace, Premarin) – stronger estrogen

Lack of Desire – Hormonal Options

• Testosterone and or DHEA -applied topically to labia and clitoris.
• Bio-identical estrogen and progesterone used in a cream for systemic absorption.

Vaginal Dryness – Non-Hormonal Options

• Fruits and vegetables – Eat fruit to bear fruit. Not that your ovaries will start dropping eggs again but fruit is deeply hydrating to your skin and tissues. Fruit provides an incredible array of flavonoids, antioxidants, vitamins, minerals, phytochemicals and countless micro and macro nutrients to the body. It is also deeply hydrating.

Fruits keep skin supple, hydrated and nourish it with essential vitamins, minerals and antioxidants, thereby retaining your radiant skin for a long period of time. Think about it There is a reason for the clichés: An apple a day, fruit of my womb, apple of my eye.

There is a juiciness about fruit that causes a juiciness in our bodies.

• Luvena & Replens – Vaginal moisturizers and lubricants sold over the counter at pharmacies.

Luvena – glycogen and cranberry extract

Replens, RepHresh – parabens, glycerin, sodium hydroxide

• Lubricants – Seaweed based lubricants – Sliquid brand, coconut oil

A lot of women are using coconut oil as a lubricant. It is a fair lubricant but after 5-10 minutes of high friction it dries out and the pain returns. You need a Plan A and a Plan B.

Plan A is background vaginal support – like luvena throughout the month, or topical estriol. Plan B is using a lubricant during intercourse. If you are only relying on a lubricant and not working to hydrate the tissue regularly then you will have break through pain.

If your sex life has been put on hold for a while because of some of these issues, I hope you got some information to help you tonight. Women needing hormonal assistance should work with a doctor who is able to prescribe and is also knowledgeable on bio-identical hormones. Once you get yourself balanced you may be the one to initiate sex or reach out to your partner to let them know that you are giving them the green light for intimacy.  

(This topic was originally the topic of my Facebook Live video. You can view that HERE)

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