September is National Menopause Awareness Month. In light of that, and in keeping with my commitment to promote a candid conversation about women’s midlife sexuality, I asked a sex therapist and an OB-GYN to talk to me about the most common sexual issues facing menopausal women, and what they can do about them.
Mary Jo Rapini, MEd, LPC is a psychotherapist specializing in intimacy, sex, and relationships, and maintains a private practice in Houston, Texas. Additionally, she is a renowned lecturer, author, and television personality. She is the co-author of two books: Is God Pink? Dying To Heal and Talking: A Girl’s Guide For You And Your Mom about Health, Sex, or Whatever.
What is sex therapy, exactly?
Sex therapists work in alliance with the medical community. They are the emotional connection between sexuality and what’s going on in a person’s life. For example, if you suffer from conflict in your relationship, no matter what medications you’re given to enhance your sex drive, your efforts will be defeated. Conflict lowers and diminishes libido.
Sex therapists help clients explore new techniques and positions when a client is suffering from a physical condition such as cancer, recovery, diabetes, or other medical illnesses. A sex therapist helps clients experience different modalities of adding pleasure to sex such as lubricants (Wet Platinum, Replens, and Rephresh) as well as non-prescription supplements like Stronvivo, which adds sexual pleasure as well as helping you feel more sexually energized.
Many women have been married in excess of 20 years without ever experiencing an orgasm. Teaching them breathing techniques, stress relief, and letting go, are part of sex therapists’ work as well.
A menopausal woman comes to see you because she has no sex drive and/or sex is painful. How would you go about helping her?
80% of women who experience painful sex learn to live with it — but dread sex. This is unnecessary as there is help and it begins with reassurance and a referral to a urologist or ob-gyn who specializes in sexual dysfunction to be evaluated. Lack of libido can be the first warning of a medical disease as well as hormone imbalance.
After a menopausal woman’s diagnosis, both she and I have a clearer path and we talk about her life and what is going on in her relationships. I assess how she feels about her body and take her sexual history. I speak to her about the importance of lubricants (my favorites are mentioned above) and help her get on a workout plan. I also encourage her (and her partner) to begin taking a supplement called Stronvivo as it helps women and men feel better about their body, as well as helping them feel more ready for sex.
I would also encourage her to experience getting to know her body. I would talk to her about vibrators, foreplay, and give her options other then intercourse to please both her and her partner. A woman should not have intercourse if there is pain. At this point, having the partner included in visits helps. I want to find out which positions they use as well as how open her partner is with experimenting and encouraging other options to enjoy sex. Oral sex, body massage, as well as reading erotic novels to one another, are all great libido enhancers and keep the couple connected with intimacy. Healthy sex is an important part of staying both physically and mentally well.
Based in Newport Beach, California, Dr. Michael Krychman is a doctor of sexual medicine, a board-certified obstetrician and gynecologist, and a clinical sexual counselor and author. He has devoted his career to helping patients and their partners overcome sexual health challenges and experience a higher quality of physical intimacy. Dr. Krychman is also a specialist in survivorship medicine and provides life coaching and care plans to optimize the health and wellness of patients with chronic diseases or cancer.
What are the primary sexual issues your menopausal patients face? About what percentage of this population deals with a decline in sexual response so troubling that they seek treatment?
Many postmenopausal women suffer from dryness and painful sex as a result of loss of estrogen stores. In addition, it’s not uncommon to have lowered sexual interest as a result of lowered estrogen and testosterone. A very small percentage of women are even treated so there is a conspiracy of silence on the part of the patient to discuss the issues of declining hormones and the impact on sexuality.
What other factors — psychological or cultural — impact a woman’s decline in sexual response?
Stress, fatigue, and distraction can impact a woman’s sexual responsivity. She is also influenced by her partner. Culturally, women have a false sense of understanding that sex may be only for the young. Society does not embrace the female who is sexually vital.
Why do some menopausal women report little or no struggles with sex? Do you have any menopausal patients who report sex is better than when they were younger, and if so, why do you think this is?
There is a subset of women who have increased confidence, stable, nurturing relationships, and do not experience some of the physical changes of menopause including dryness and pain, and they have increased sexual function. Many women who are healthy, have good diets, and exercise may also have good golden-year sex. Physical health, excellent communication, and making sex a priority for the couple are important facets for maintaining a healthy sex life.
What are the different options for menopausal women seeking treatment for decline in libido and other physical problems they experience with sex?
For vaginal dryness, moisturizers like Replens and Rephresh, and lubricants such as Replens Silky Smooth or Wet Platinum are great. Locally applied, minimally absorbed estrogen products are available in cream, ring, vaginal tablet, and oral medications to help restore and rebuild the vaginal epithelium.
For libido, Addyi is the only FDA-approved medication For premenopausal women. There have been some studies on this medication but it presently is not available for the postmenopausal group. Other interventions include bibliotherapy, self-stimulators, cognitive-behavioral therapy, herbs, and supplements like Stronivvo and Arginmax that promote blood flow, and that may help in some cases. Off-label testosterone and the antidepressant Wellbutrin are libido-enhancers, but they also have risks and side effects.
HRT: safe or not?
You must discuss your specific medical history, risks, and family history with your healthcare provider. For many women, hormones may be a viable alternative and is not the root of all evil!
Some women have told me that the sexual problems they thought were permanent disappeared when they left unhappy marriages and explored their sexuality with new partners. Have you found this to be true in your practice?
Sometimes the best treatment is a partner-ectomy or husband-ectomy. Bad relationships that are non-nurturing, destructive, or combative, can zap the sex drive. It is understandable that in an uncaring, unloving, and destructive scenario, sexual feelings, drive, and interest would diminish.
What message do you want to get out to menopausal women who struggle with a decline in sexuality or feel that they are not desirable?
You are not alone! There are safe, effective interventions, from the most conservative to the intensive, that can help restore sexual function. Sex is a vital aspect of the human spirit and has many medical benefits. Break the conspiracy of silence and ask for help, which is available.
The information provided in this site, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider.