Where, Oh Where Did My Libido Go
An article from Rebecca J. Hulem, RN, RNP, Certified Menopause Clinician…
If there’s one topic that’s "very hot", no pun intended, it’s sexual dysfunction in women. It’s something many of us can moan about. In fact, women who have attended my seminars on menopause have been "treated" to me singing the following limerick as I introduce the topic of Female Sexuality and Aging.
Where, oh where did my libido go?
Oh where oh where could it be?
As I lie here in bed
With my vibrator that’s dead...
I much prefer chocolate instead!
Millions of women who are now passing through menopause are complaining and, very surprised to discover, that they have absolutely no desire to have sex anymore. If this is how you feel, know that you are not alone!
Even though the lack of sexual desire is the most commonly heard complaint of a woman in menopause, doctors and sex therapists have now divided sexual dysfunction into four categories. These are:
Low sexual desire - you have decreased libido, or lack of sexual desire
Sexual arousal disorder - your desire for sex has not changed, however you are unable to become or stay aroused during sex
Orgasmic disorder - you have persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and stimulation
Sexual pain disorder - you find sexual stimulation painful or you have vaginal pain with touching
Keep in mind that even if you can identify with any or all of the above categories, it’s not considered a sexual disorder unless you’re distressed about it, or it negatively affects your relationship with your partner.
There are four factors that may cause or contribute to sexual dysfunction. These factors are:
When treating sexual dysfunction in women it is important that all four factors be taken into consideration and explored before any treatment is prescribed.
It is tempting in our "pushbutton", "quick fix", "hurry-up-and-get- it-done" society to jump on the hormone bandwagon. However, hormones may or may not solve the problem, and so should not be considered lightly. Remember that for women, sexual response is complex and involves a mind-body connection. Yes, indeed, women are complex creatures - unlike their "simplistic" male counterparts, who manage to have a sexual thought every 7 - 9 seconds!!!
If after careful consideration, hormones (or lack of them) do appear to be the main culprit, the following guidelines may apply:
Estrogen is needed for proper response of vaginal tissue (lubrication and clitoral engorgement)
Estrogen can be used "locally" for proper vaginal response without putting the whole body at risk for long-term disease (breast and uterine cancer)
Testosterone may contribute to increased desire. However, in order for testosterone to work properly, the body needs estrogen first
Examples of commercially-made estrogen products that can be used locally, i.e., inside the vagina, are Estring® and Vagifem® tablets. Ask your health care provider for more information.
Testosterone presents a trickier situation. Most commercially-made testosterone products on the market right now are intended for men and are at much higher doses than women can tolerate. Estratest®, which is FDA-approved for hot flashes, has been given to women for libido problems. However, the results have been disappointing. Bio-identical, compounded testosterone is another option which can either be applied locally (to vaginal and clitoral tissue), or taken by pill or capsule. There are also promising new possibilities waiting in the wings for FDA approval. An example of this is a testosterone patch. In its trials so far, it does appear to be proving an increase in the sexual desire so many women long for. Stay tuned.
Talk frankly to your nurse practitioner, nurse midwife or doctor about the different courses of treatment they recommend, and talk frankly about what you can expect as you age. Then communicate this knowledge to your partner. Remember, you never outgrow your need for affection, emotional closeness and intimate love. The need for intimacy is ageless and essential. So communicate openly and honestly with your partner, and it will free you both to discover a deeper, more satisfying level of sexual intimacy than you may have ever imagined. I’ll leave you with this great quote from Agatha Christie:
"An archaeologist is the best husband a woman can have; the older she gets, the more interested he is in her!"
For more information about sexual changes during menopause, check out the chapter entitled "Where, Oh Where Did My Libido Go?" in my book, Feelin’ Hot?. You’ll find a more detailed explanation of the causes of decreased libido, and an eye-opening discussion about the differences in how men and women approach sex. Plus, you’ll also learn how to create the "Perfect Sex Date" with your partner!
Rebecca J. Hulem has 28 years experience in the medical community and is the author of "Feelin’ Hot" and contributing author to two additional books. To sign up for her free menopause newsletter or for further information, please refer to her website at http://themenopauseexpert.com.