Keep Sex Life Sweet Despite Menopause

Doctors can help women enjoy intimacy as they age

One-third of women over 50 struggle with some kind of sexual problem, but most can improve their love lives by focusing on the problem and making some changes, doctors report.

"Many women have talked themselves out of sex after menopause," said Dr. Gail Saltz, a New York City psychiatrist, by convincing themselves their marriage is fine without it, or they're simply not interested in sex anymore.

"But sex is good for you -- it reduces stress, improves sleep, is a good form of exercise, fights aging both physically and psychologically, and enhances the bond with your partner," she said.

Saltz made her remarks Oct. 21 at the annual Women's Health Symposium in New York City. She was one of four doctors at the conference who spoke on stress, the physical and emotional issues that affect a woman's sex drive as she ages, and research into men's and women's brain functions.

There are many physical reasons why women suffer from sexual dysfunction as they age, said Lauri J. Romanzi, a clinical associate professor of obstetrics and gynecology at Weill Cornell Medical College in New York City.

"Motivation is gone, and the ability to be aroused is reduced," she said, which can be due to any number of physical changes that happen to women..

Reduction of hormone levels, which begins at age 35 to 40 and increases significantly around menopause, may lower a woman's interest in sex, as well as cause a decrease in physical sensation in the vaginal area. Weak pelvic muscles can also affect how an older woman experiences orgasm, as can a prolapsed uterus or a dropped bladder -- often the result of childbearing. And worry about urinary incontinence also could prevent a woman from enjoying sex, the speakers noted.

Certain medications -- including those that treat blood pressure, ulcers, depression, even birth control pills -- can also lower a woman's interest in sex, Romanzi and Saltz said.

Equally important is what's on your mind, said Saltz, an associate professor of psychiatry at Weill Cornell Medical College.

"Psychological issues are most often the major contributing factor to sexual dysfunction," she said. "When you're over 50, you could be raising teenagers, dealing with aging parents, facing an empty nest or retirement, or dealing with health problems that begin to crop up. All of these problems can get into bed with you.";

Women at this age may also worry their body doesn't look as good as it did when they were younger, or feel they're less feminine because they've gone through menopause. This can lead them to avoid sex with their partners because they're afraid of rejection, Saltz said.

Then, there can be problems between a woman and her partner -- "If you're angry with your husband, you don't want to have sex," she said.

Fortunately, there are many answers for women today.

"Until about five years ago, sexual dysfunction was only about pain," Romanzi said, but now there's more emphasis on helping women to stay active sexually as they age.

Topical creams, vaginal tablets and hormone supplements -- including a new testosterone patch, which will be available in 2005 -- can improve a woman's sex drive, although such medications need to be carefully monitored by a doctor, Romanzi said.

She also said, "Kegel exercises are the big, secret boon to sex." By strengthening these muscles, which your doctor can teach you to do, you strengthen vaginal muscles, and that can improve how you experience an orgasm.

Doctors can treat other physical symptoms, such as prolapses and urinary and bowel control functions, so a woman can improve her sexual response.

On an emotional level, Saltz recommended first of all "prioritizing intimacy."

"You have to be willing to put it at the top of your list," she said..

She also suggested that women not be shy about indulging in sexual fantasies; be willing to try new things with your partner, and masturbate so you know what gives you pleasure. And talk to your partner about your fears, Saltz said.

"Only action brings change," Saltz added. "Change a little thing to make you feel differently. If you and your husband have a glass of orange juice every morning, put a little umbrella in it and have a mimosa."

The conference was presented by New York Weill Cornell Medical Center, Weill Cornell Medical College and New York-Presbyterian Hospital, all in New York City.