Hrt and menopausal symptomcontrol: sex life

HRT AND MENOPAUSAL SYMPTOMCONTROL: SEX LIFE
Like psychological problems, sexual difficulties around the menopausal years are complex because they are affected by a wide range of social, environmental and interpersonal influences that may have little or nothing to do with menopause. The Melbourne Women's Midlife Health Study found that sexual interest and activity did not change significantly in about 62 per cent of women who had had a natural menopause, while 31 per cent reported that they felt less sexually interested, had sex less often, and found it more
painful than previously. Approximately 7 per cent said they were more sexually interested and active, and some attributed this to a new partner in their lives.
Since sexual activities involve two partners, it is important not to assume that difficulties originate on the female side. As men age they tend to experience increasing problems with libido, erections, orgasmic capacity and penile sensitivity. This may compromise their sexual interest or capabilities. When Leah was fifty-seven, her husband Brian, aged sixty-four, suffered a heart attack. Although he was soon back at work, his sex drive all but disappeared and he had difficulty getting an erection. During counselling sessions he revealed that he feared dying during sexual activity, and that this weighed heavily on his mind.
In other couples, sex literally becomes a bruising experience. Some, but not all, women experience vaginal dryness and thinning of the vaginal lining after menopause, and this may make intercourse painful. This symptom is more frequent among postmenopausal women than their younger sisters, but is not confined to the postmenopause. A study of women in the south-east of England found that 40 per cent had this problem after menopause, but 26 per cent of premenopausal women also did. If the problem of painful intercourse becomes established, it can lead to lack of confidence in both partners and things may go from bad to worse.
This chapter looks specifically at the role of HRT, but hormone therapy is certainly not the whole answer to sexual difficulties around the time of menopause. There is some evidence that sexual problems will respond to HRT by its direct effect on vaginal lubrication, the vaginal lining (causing it to resume its former thickness), blood vessels and blood flow in the vagina, vulva and uterus, and perhaps also transmission of messages along nerve pathways to the genital organs. Oestrogen and testosterone seem to be the only hormone therapies that improve libido in women, although they are not universally effective.
Before embarking on HRT in the hope that it will improve your sex life, it is important that you explain the problem to your doctor in detail. Specialised sex therapy may be required, no matter how good your response to hormones, since the problem may have set in train patterns of sexual behaviour that are difficult to undo.
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