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Female Sexuality at Midlife Helping women deal with

By Joyce Flory, PhD We have to redefine the concept of midlife tant in developing the or sex drive in as women’s life expectancy grows. A both women and men. Declining levels of Epidemiological studies reveal that around woman may have two midlife experiences- during midlife can affect a 10 million women between the ages of 50 one related to reproduction and the other woman’s sexual urge. Also affecting testos- and 74 report sexual complaints, including related to chronological age. terone levels are medications such as birth decreased , inability to reach used to occur at the end and increased with intercourse. Re- of a woman’s life. Now, searchers have begun to realize that sexual it occurs at the middle. response involves a complex interaction be- During the peri- tween and the nervous vascular menopause, erratic ovar- and the musculoskeletal systems. ian function leads to Sexual dysfunction can be a problem varied levels. for women of any age. However, women in Estrogen levels decline, midlife are especially prone to changes that causing a decrease of sometimes result in sexual dysfunction. blood flow to the geni- Understanding how the changes in midlife tals. This, in turn leads affect sexual response is an important first to changes that might step in helping women deal with sexual affect sexual function. dysfunction. Some women face changes in the , How many women suffer from some sort of including a narrowing, sexual dysfunction? a dryness, an increase Researchers at Yale School of Medicine and in pH, which can lead the Albert Einstein College of Medicine re- to infections, and a de- port that female sexual dysfunction (FSD) crease in elasticity of the affects 48.2% of women. vaginal wall. Changes in a woman’s bladder can What’s new related to women and sexual lead to frequency in uri- function and dysfunction? nation or loss of urine. Research shows that a woman can fool Changes in her clitoris can lead to de- control pills and estrogen therapy taken her partner by faking an orgasm but a creased blood flow. And nerve changes by many women in midlife. brain scanner will probably catch her. may mean that a woman has to cope with For women who are nearing meno- Researchers at the University of Groningen decreased sensitivity to touch and that pause, relationships and attitudes seem to in the Netherlands used scans to show she needs more time to respond to a phys- affect sex more than menopause status. In that different areas of the brain are stimu- ical sensation. an article published in the July/August issue lated during an orgasm but aren’t activated Vaginal dryness and the decrease in elas- of Menopause, researchers report that when a woman fakes an orgasm. ticity of the vaginal wall can even lead to of 3,000 women interviewed, those with The brain scans for men during orgasm discomfort and pain during sex. Lack of the best sex lives have healthy relationships are less conclusive but reveal that different blood flow to the genitals means low vas- and positive attitudes about sex and aging. parts of the male and female brain are ac- cular congestion in the vagina and clitoris. Vaginal dryness and pain during sex tivated and deactivated during sexual stim- And that, in turn, can mean delayed arous- also seem to affect women’s sex lives. ulation. So when people say that the sexi- al, delayed or absent orgasm, or diminished est organ in your body is the brain, they’re intensity of orgasm. How does male sexuality influence women? being truthful. Many women fail to realize that they A woman’s male sex partner can definitely make more testosterone than estrogen. In affect her sexual response. In midlife, men How do midlife changes influence female fact, all of the estrogen made by the ovaries go through a decline in testosterone pro- sexuality? is from testosterone. Testosterone is impor- duction as well as other changes, such as de-

16 clines in libido, penile sensitivity, and blood bound to experience a decline in libido. How about the impact of medical issues on flow to the genitals. A man may not be able Men aren’t the only ones to experience sexual dysfunction? to achieve or maintain an . performance anxiety. A woman may fear Medical issues, such as coronary artery and The man may face performance anxiety pain during sex because of vaginal dryness renal disease and arthritis, can diminish sex- where fear of failure leads to ongoing sexu- or changes in her vagina. She may not feel ual desire and . Just as troubling are al dysfunction. If the pattern continues, a satisfied. Or she assumes she won’t be able conditions such as Parkinson’s disease, man may withdraw from sexual encounters to satisfy or please her partner. If a man has complications of , pituitary tu- or any expressions of intimacy. The man’s performance anxiety, the woman may mors. and alcohol and drug abuse. And we behavior has a profound impact on his avoid any sexual contact. After all, why can’t forget about the impact of psychiatric partner, who associates expressions of inti- would she take the risk of forcing him to or emotional problems such as depression. macy with desire and sexual response. fail? And why would she want to confront Medications for blood pressure, psychi- her own perceived inadequacy to arouse atric conditions and colds and allergies can How do midlife women experience changes him sexually? influence sexual desire. Also influencing in libido? testosterone levels are birth control pills and Decreased libido or sexual desire is a What about the impact of relationships on therapy. common complaint of women in peri- sexuality in midlife? Going back to the impact of depression, menopausal transition. However, decreas- It’s a two-way street. When a man and we can’t minimize the role of selective es in sexual appetite, drive, and fantasy can woman experience emotional problems in serotonin reuptake inhibitors, or SSRIs. happen at any time in a woman’s life. a relationship, these problems tend to in- Used to treat depression or premenstrual It’s easy to look at physiolog- fluence the sexual relationship. In the same disorders in perimenopausal women, these ically. However, libido is more behavioral way, sexual problems almost always affect drugs can sometimes improve sexual and psychological. the emotional quality of a relationship. function by treating the underlying Women and men can have normal Men and women change over the depression. However, a woman who takes levels of testosterone and still experience a course of a relationship or marriage, but these medications may also face dimin- diminished desire for intimacy. Just consid- they don’t always change to the same ished sexual desire and altered arousal er the reality that men tend to live longer degree or in the same direction. A woman and orgasm. than women do. This results in a shortage who was strongly attracted to a man at Surgery can also have a profound im- of men of a certain age. Men sometimes age 35 may feel him as unappealing at pact on female sexuality and responses. seek out younger women, which also age 55. Another woman may become Surgeries involving the and genital influences the availability of partners for a bored with the sexual routine, feeling like area can affect body image as well as the midlife woman. she’s watching reruns of an old sitcom on ability to function sexually. A diagnosis A woman needs to feel good about her- Nick at Nite. such as or heart disease can also self to take interest in sex. If she doesn’t feel We can’t ignore the role of communica- affect a woman’s sexual response. she’s at her best––both physically and tion or the lack of it. A man and woman Many physicians have debated the role emotionally––she’s not likely to have a with a sexual problem or issue often choose of hysterectomy in improving or diminish- strong sex drive. to ignore it. As a result, the sexual problem ing sexual function. If the surgery relieves We can’t ignore the impact of takes on a power far beyond the confines of symptoms such as bleeding or pain, a and socioeconomic status on sexuality. the bedroom and erodes the relationship. woman may develop a more intense inter- Sexual dysfunction is high among women A woman may fake an orgasm to avoid est in sex. On the other hand, a woman plagued by low income and poor - confrontation or pretend to be busy, tired, who’s had a hysterectomy can experience a al and physical health. or unwell––just to avoid sex. The situation decline or absence of orgasm. And let’s not forget a woman’s past ex- is particularly difficult for the man and It’s important for a woman to remem- periences. A woman who was brought up woman who never developed an ability to ber that her ovaries continue to produce in a home organized around a set of unre- tackle and discuss an issue. No matter what testosterone even when they no longer alistic or unhealthy moral and religious kind of sexual issue arises, this man and produce estrogen. This means that it’s beliefs is likely to have problems coping woman can’t help each other understand no longer appropriate to remove the ovaries with sexual issues. what’s needed to achieve sexual satisfaction. along with the uterus to prevent future It’s easy for a woman to feel less desir- Relationship problems often get played ovarian cancer. It’s also important to main- able as she ages given our youth-obsessed, out in the bedroom. A man or woman may tain the cervix due to its role in providing competitive culture. A woman in midlife want to punish a partner for a past foible blood vessels and nerves to the top of the may face weight gain or redistribution as or episode. Disrespect, dishonesty, and lack vagina. This, however, is controversial well as changes in skin and muscle tone. If of build up over the years and often in the medical community. Some physi- a woman feels unattractive and unsexy, she’s culminate in low sexual activity. cians feel that having the cervix does

17 nothing to improve sexual responsiveness Do medications play a role in treating sex- Resources and sensation, while many others believe ual dysfunction? that it does. Estrogen can affect a woman’s sexual func- American Association of Sex Educators, tion by helping with lubrication and vagi- Counselors, and Therapists How can physicians help in the treatment nal elasticity as well as nerve growth and www.aasect.org of sexual dysfunction? lifting of mood. In one study, estrogen in- American College of Obstetricians and Physicians need to know that even though creased clitoral sensitivity, rate of orgasm, Gynecologists www.acog.org sexuality is a complicated issue, lifestyle and sexual desire. In another, the rate of changes can generate a profound impact. orgasm and sexual arousal weren’t affected. The Alexander Foundation for Women’s These changes can include drinking more However, women were more satisfied with Health www.afwh.org water, smoking cessation, and/or strength the frequency of sex, sexual fantasies, Association of Reproductive Health Pro- training and aerobic exercise. Strength sexual enjoyment, and . fessionals www.ahrp.org training, in particular, can increase libido, However, not every study is positive. Atlas of the Body: Female Reproductive decrease depression, enhance body image, Women may experience a decline in testos- System www.medem.com and boost testosterone levels. terone, which reduces sexual desire. Some Any suggestions to stop having sex studies show that progestins increase sexu- ClinicalTrials.gov won’t work. Sexual activity begets sexual al problems in women, although hormone www.clinicaltrials.gov activity. Women can experience some of combinations may be more effective. FSDInfo.org - Information on Female the benefits of sex through masturbation treatment is still controver- Sexual Dysfunction www.fsdinfo.org and . However, physicians sial. In terms of studies, the results are Female Sexual Dysfunction: Overview should stop short of recommending that a mixed. can decrease HDL. and Sexual Response Cycle www.urology woman has sex a specific number of times When given in high doses, they can pro- channel.com per day, week or month. Both men and duce masculine changes such as hair women need to accept the notion that not growth and acne. Combined estrogen and International Society for the Study of all sexual encounters need to culminate in androgen therapy can help a woman who’s Women’s Sexual Health www.isswsh.org traditional intercourse and orgasm. had both ovaries and uterus removed. Journal of Sexual Medicine Physicians can refer patients to psy- A study published in the July 6, 2005, www.blackwellpublishing.com chologists or relationship therapists who issue of the Journal of the American Medical Kinsey Institute www.kinseyinstitute.org can help them communicate sexual likes Association reports no connection between and dislikes in a non-threatening way. Cou- a woman’s level of androgen and sexual MedBioWorld: Sexuality Journals ples with long-standing communication functioning. The results seem to contradict www.medbioworld.com problems will need extensive therapy, while the idea of using testosterone to treat low Medical Institute for Sexual Health others may benefit from sexually oriented sexual desire disorder. www.medinstitute.org videos and erotic literature. A midlife A study in the July 25, 2005, issue of Menopause Web Reference woman who’s experienced decreased the Archives of Internal Medicine reveals that www.womanlab.com blood flow to the genitals may need in- a testosterone patch can improve sexual creased manual or oral stimulation to interest and activity in women who have National Association of Nurse Practition- achieve arousal. low desire following removal of their ers in Women’s Health www.npwh.org Some women have strengthened mus- ovaries. However, many still question tak- National Vulvodynia Association cles in the vaginal area by using vaginal ing steroids. The FDA turned down a re- www.nva.org weights, which can both improve sexual quest to make a testosterone treatment The North American Menopause Society response and control urine leakage. A available to women. www.menopause.org woman inserts a light weight into her Many women have faith in herbal ther- vagina and holds it there for 15 minutes apies, although evidence on their effective- Nurture Your Nature twice a day. After improving the muscle ness is limited, and many physicians ques- www.nurtureyournature.org tone in her vagina, she moves on to the tion the safety and nonregulation of these Society for Sex Therapy and Research next level weight. products. Among therapies under discus- www.sstarnet.org sion are St. John’s Wort; Ginseng; Don Vulvar Health www.vulvarhealth.org Quai; Yohimbine; Ginkgo Biloba; and l-Arginine, an amino acid. However, only Women’s Sexual Health Foundation Yohimbine, Gingko Biloba, l-Arginine, and www.twshf.org some topical creams for the clitoris seem to Joyce Flory, PhD, is a Chicago-based increase sexual desire and sensation. ❙ ww healthcare researcher and journalist.

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