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Sexual dissatisfaction in the menopause

Dear doctor, I am in the early 50s, and 2 years into the menopause. I have an increasingly dissatisfying sexual life. Can this be remedied?

Menopause signifies the end of natural reproductive potential, but not the end of sexual activities. The inevitable hormonal changes in the menopause have consequential effects on the functioning of the genital system. Women and their partners will thus experience new changes in sexual function, which may sometimes interfere with sexual enjoyment and satisfaction.

Sexual function is controlled by an interplay of complex mechanisms. Such mechanisms involve the brain, reproductive hormones, and the eventual physical interface. Any interference with some or all of these mechanisms is bound to have a negative effect on sexual function. Chronological ageing involves a combination of hormonal and physical bodily changes, leading to inevitable reproductive and sexual response sequelae.

The menopausal hormone deficiency state leads to easily noticeable sexual changes. There is lowered libido, meaning that there’s hardly any significant interest in sex. Lack of ample circulating hormones causes vaginal dryness. This interferes with lubrication, sometimes making sexual attempts quite uncomfortable or even impossible. The lax pelvic and vaginal muscles arise from a multiplicity of causes that include previous childbirth, ageing and even hormonal deficiency. Sex will hardly be enjoyable if there’s hardly any vaginal muscular tone.

Sexual partners may also play a role in the evolving sexual function in the menopause. Your partner may have a significantly declined interest in sex due to a combination of many factors. They may find you less attractive, or just get disinterested due to difficulties experienced with vaginal dryness or poor muscular tone. They may have problems of their own too, like erectile dysfunction and declined libido, which may have a knock-on effect on you as well.

It’s not all a sad phase of sexual life though. There are ample remedies to help those who find themselves in some sort of sexual limbo. Once you realize there’s a problem, seek help promptly. You can start off with your gynecologist, or even a sex therapist. A quick general assessment will identify the most likely explanation of your sexual dissatisfaction. Hormonal, or non-hormonal creams can help with vaginal dryness, making sex less difficult forthwith. Depending on additional menopausal symptoms, some women may benefit from hormone replacement therapy. There are specific hormone medications that can be given to help with libido.

Extensive pelvic and vaginal muscular changes are more difficult to address. Pelvic floor exercises have a role, while some women may benefit from pelvic floor surgery depending on specific circumstances. Your partner should also have any sexual issues on their end addressed. Ample help is out there to get you back to an enjoyable sexual life.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist.

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