Rated “M” For Mature

Looking back, it’s hard to believe I’ve been writing this blog for 3 months.  It’s even harder to believe I’ve gone this long without talking about sex.  Seems like I talk about it all day long in the office!

I had a lady in the office recently, a good friend and long-term patient.  She was there for her annual physical and GYN exam.  I always ask about sexual activity, and she mentioned that things were getting uncomfortable in that area.  In fact, she was a little aggravated, because her kids were now grown and out of the house.  It seemed unfair that, although she and her husband were now more able to be spontaneous and frisky when the mood struck, menopause had made it so that she was LESS interested than in the past.

Let’s face it guys, if sex was painful for you, would you want to do it?  No matter how much you loved your wife/girlfriend/lover/etc, if sex hurt you would think twice.  I’d like to review for my readers of BOTH genders the physical reasons why ladies of a certain age might get rapidly less interested in sex.

At menopause, the ovaries stop making estrogen.  It’s usually not like flipping a switch, but rather they will sputter to a stop.  Menstrual periods get less frequent and eventually stop altogether.  She may get hot flashes and night sweats, have trouble sleeping, and be more cranky than usual or get downright depressed.

It’s interesting that although the ovaries go on permanent vacation at menopause, the adrenal glands continue to make weak male hormones throughout life.  This seems to be why women struggle with acne and male-pattern hair growth around menopause.  The body’s fat tissues have enzymes that change those weak male hormones into weak estrogens.  This may give women who carry more body fat gentler menopause symptoms.  Here’s one of the few areas where women who are slender are at a disadvantage!

The one area of the body that is most sensitive to blood estrogen levels is the perineum, the area around the opening of the vagina and urethra.  Estrogen keeps those tissues strong, stretchy, and able to lubricate themselves.  The most incredible example of this elasticity is the perineum’s ability to stretch without tearing to let a baby’s head out at childbirth.  Estrogen also makes the vaginal secretions acidic which helps to protect against infection.

After menopause estrogen levels fall rapidly and the skin and tissues of the perineum lose the ability to stretch.  The skin gets fragile and thinner, and the secretions decrease significantly and become more alkaline.  Urinary infections become more common due to these changes, but by far the most obvious consequence of these changes is painful intercourse.

The good news is that there is an easy treatment for this problem.  A little bit of estrogen cream is the treatment of choice for menopausal women whose main (or only) symptom is pain with sex.  It’s only used twice a week and very little is absorbed into the bloodstream, so it is generally considered safe even for those concerned about the risks of hormone replacement.

I hope any of my female readers who are troubled by painful intercourse after menopause will make an appointment with their doctor to discuss the options.  My gentleman readers of a certain age who are experiencing resistance to sex should have a frank discussion with their partner about whether pain is playing a role.  I might gently caution you not to take the “Honey you’ve got to get this fixed” approach.  A supportive and sincere concern for HER pleasure in your intimacy will go much farther.

Achieving menopause doesn’t mean that your sex life shouldn’t be as active and fulfilling as it was when you were younger.  Giving up the fun of menstrual periods should be a joyful occasion, not shadowed with the loss of physical intimacy due to pain.  Be open and honest with your lover, keep your sense of humor, be adventurous!  Getting older isn’t for sissies!

PS – I am making the VERY large assumption in this post that both members of a perimenopausal couple WANT to continue to be sexually active and that the only thing standing in the way of their mutual satisfaction is pain due to vaginal dryness and tissue fragility.  A complete discussion of all the psychological reasons that a couple’s sex life can go awry is WAY beyond the scope of this post.


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