Female Sexual Functioning at Menopause and After

The effect of menopause on female sexual functioning has been a concern for quite some time as the underlying hormonal changes of the menopausal status are thought to have an adverse effect on her sexuality. However, a woman’s body works fine sexually during menopause and the later years. She remains robustly capable of functioning in all aspects of sexual response: desire, arousal, and orgasm. However, due to the anxiety about their perceptions of themselves as less feminine and less desirable, some women may express fears about their partner’s fidelity.

The increase in the number of menopausal women due to increased lifespan has generated more interest in the sexuality of women in menopause. As at 2000, the number of women aged 50 years and older was approximately 42 million in the United States alone. However this has not affected the age of onset of menopause (approximately 51) but only increased the time women spend in menopause due to the increased longevity.

Survey data generally show a considerable incidence of problems in various aspects of sexual functioning in postmenopausal women. Various studies have reported a 10 – 85% decrease in sexual interest and a 16 – 47% decrease in the frequency of orgasm in menopausal women. For example, an Australian study of about 2001 women aged between 45 and 55 years, showed that reduction in sexual interest was significantly linked with natural menopause rather than age or other factors. The results of the study revealed that women showed a significant decline in factors such as sexual responsiveness, frequency of sexual activities, libido, and feelings for partner as the women passed through the menopausal transition.

Also, there have been expressed concerns about the linkage between menopause and depression in postmenopausal women. In a 2003 study of American women, it was found that about 25% of the women reported significant distress about their own sexuality. However, the study showed that though older women more commonly experienced sexual problems, it was the younger women who were more likely depressed by them. The study concluded that not all menopausal women with low sexual-functioning seemed to be distressed.

Hormonal Effects on Women’s Sexuality in Menopause

Women in menopause can use guidance regarding the impact of chronic illness and medications on sexual functioning. Thus clinical trials and surveys have attempted to provide information on the prevalence, and types of sexual complaints associated with menopause. Most of these researches have focused mostly on the hormonal effects on specific aspects of sexual functioning.

As hormone production is linked to menopausal status, in most women sexual functioning becomes a function of aging. Studies have found that exogenous estrogen alleviates atrophic vaginitis and associated dyspareunia and increases vaginal lubrication. Also, several prospective studies of surgically menopausal women, however, have demonstrated that the addition of testosterone, which is normally produced by the ovaries, to an estrogen replacement regimen increased sexual desire, sexual arousal, and the frequency of sexual fantasies compared with women treated with estrogen alone.

Female sexual response during menopause and after

Medications and medical treatment can affect all aspects of sexual response, and as women age, the chances naturally increase that they will undergo medical treatment for some illness or condition.

Sexual Desire

While there is a general decline in sexual desire in menopausal women, there seems to be an increase in sexual interest and activity in women over the age of 65. This may be due to a newfound freedom and sense of control over her time and environment. The hormonal changes of menopause can dampen a woman’s desire because of the discomfort of dealing with the symptoms and because of the reduced estrogen and androgen.

Sexual Arousal

Sexual changes following menopause are often most obvious during the arousal phase. The mucous membrane tissue of the vagina and part of the vulva may have become thin and prone to irritation and minor injury. Lubrication diminishes during and after menopause, so the sensitive tissues are more susceptible to damage from vigorous sexual activity, especially heterosexual intercourse and other penetrating sexual activities. Also, the cushiony thickness of the vaginal walls and the Venus mound decreases, so some of the insulation against active sexual play is diminished, particularly sex involving penetration or lengthy periods of direct stimulation.

Orgasm

Regular sexual activity and orgasm help maintain a woman’s sexual health. Women who masturbate or have regular sex with a partner actually continue to lubricate more rapidly and have more estrogen circulating in the body, even if they show signs of vaginal atrophy (thinning of the vagina). In fact, "use it or lose it" may be truer for women than for men. Because vaginal tissue tends to atrophy and lose elasticity not only due to lowered estrogen levels but also to lack of stimulation and stretching. Regular lubricated sexual intercourse or the use of a deep penetrating vibrator can help maintain healthy tissue, promote lubrication and minimise shrinking of the vagina.

Non-hormonal Effects on Women’s Sexuality in Menopause

Numerous non-hormonal factors may also influence sexual functioning in postmenopausal women. Clearly, one such factor is the desire and capacity of her and her partner for sexual activity. There is a positive relationship between a woman’s previous sexual life and her postmenopausal sexual life in terms of her previous sexual interest, importance of sex and the frequency of sexual activity.

Another important factor that should be considered when dealing with women sexuality in menopause is the length of the relationship she is involved in. Statistically, the frequency rate of sexual intercourse is reduced to about 50% over the first year of marriage compared to premarital frequency rates and is halved again during the next 20 years. Thus female sexual desire towards a partner can vary over time.

Finally, cultural and societal notions of sexual attractiveness and attitudes concerning the expression of sexuality beyond the reproductive years also have a significant influence on the maintenance of sexual activity in middle-age and elderly women.

Tags: hormones, menopause, sexuality