FAQ: Menopause and Sexual Issues

Patient Expert

Q. Since I've started going through menopause, I'm really not in the mood for sex very often. And even when I am, it's painful What's going on?** A.** Loss of sexual desire and painful intercourse are two hallmarks of menopause. The villain is your body's lack of hormone production. Your ovaries' and adrenal glands' production of estrogen and progesterone diminishes over time; and, while it takes longer, eventually testosterone production lessens, too.

What does all this mean? Testosterone is the hormone that produces sexual desire (libido) in women. Without it, you have a hard time getting excited at the prospect of making love. Think of how you felt, sexually, as a child; the lack of testosterone is taking you back towards that libido-free zone.

What can you do about this? It used to be thought that testosterone cream, applied topically to the vagina, would bring back your feelings of sexual excitement; but recent studies have pretty much disproven that. So, you may have to work a bit at finding ways to make up for that lost testosterone. Since there's probably not much you can do, hormone-wise, to change your situation, you're going to have to use your mind and emotions to try to get some of that libido back.

Q. Maybe eventually I'll figure out some strategies for making love-making more appealing. But I'm afraid it's still going to hurt. Why is it so painful now?** A.** Painful intercourse is the result of your vagina becoming dry, and its walls becoming thinner. Like hot flashes and "permanent PMS," this vaginal dryness is the result of the decrease in estrogen and progesterone-brought on by that darned menopause. You may even find you'll have some bleeding after intercourse-just like being a virgin again, eh?

What can you do about this dryness? First, you can try some over-the-counter remedies. Replens ®, Vagisil ®, or their store-brand counterpart can be found at any drugstore. Basically, they're body moisturizers designed specifically for your vagina. You apply them regularly, several times a week (via the same type of applicator you'd use for yeast infection medication), and they make your vagina softer, moister, and more pliable, and thus sex more comfortable.

Another remedy might be as close as your kitchen cupboard: olive oil. A bit of olive oil, applied around the entrance to your vagina (where it hurts), does the same thing as body moisturizers: it keeps your vagina soft and pliable. Be sure to use nearly odorless, extra-light olive oil (so you don't walk around accompanied by "eau de salad bar"!) And it helps to wear a panty liner, to absorb any excess oil.

Another thing you can try is a vaginal lubricant, designed to be used just prior to intercourse. (By the way, tell your partner he or she is NOT the reason you're unable to lubricate; it has nothing to do with desire, and everything to do with your hormone level.) Astroglide ® is a lubricant many women like, but check out all the offerings at the drugstore; they'll be in the same section with the condoms. (By the way, petroleum jelly isn't recommended; it may promote infections.)

Q. Is there anything else I can try, if none of that works?** A.** Yes, there is. Estrogen cream can be applied to the external lips of the vagina to provide relief from dryness. In addition, there's something called Estring ® (a ring of the drug estradiol) that can be inserted into the vagina, much like a diaphragm, and left there for three months. As it gradually releases the drug, your vagina will become moister, more like it was before menopause, and love-making should become a heck of a lot less painful.

Don't be afraid to discuss any of this with your doctor. He or she won't be uncomfortable talking with you about your sex life. It's the doctor's goal to make you comfortable with these changes you're going through, and that means healthy in all ways. Suffering in silence won't do you or your partner any good. Take that first tough step by bringing up any sexual issues you're experiencing at your next appointment, and see where the discussion takes you. You may find a happy ending to the menopause story yet!