As most people reach middle age and beyond, they decrease their frequency of sexual activity. In women, this typically starts during menopause. Some may think this decreased activity is due to a lack of interest, but a presentation at the recent North American Menopause Society in Philadelphia suggests that often the cause may be physical.
A study, from the Kaiser Permanente Center for Health Research in Portland, Oregon, was conducted as a survey of over 1,500 women age 55 or above. The women were questioned about their frequency of sexual activity, any history of pain or other problems during intercourse, and if they suffered from any vaginal or urinary issues such as leakage during intercourse.
Regarding sexual activity
Forty-eight percent of the women reported that they had no partnered sexual activity for at least 6 months. When asked why, 47% said it was due to lack of a partner. Fifty-five percent of those with a partner said he lacked interest in sexual relations or had physical problems limiting his sexual abilities.
Twenty-six percent of the sexually inactive women said their sexual inactivity was due to vulvovaginal dryness, itching, or pain. Twenty-four percent said that painful intercourse was the reason they avoided sexual activity. Seven percent said they had bladder leakage, urgency, or too frequent urination around the time of intercourse.
A high percentage of the women who were sexually active reported pain or discomfort during intercourse—45%. Women who did not use lubricant reported the problem even more frequently.
Cause of urinary and vaginal problems
When a woman reaches menopause, her estrogen levels fall and this leads to thinning of the vaginal tissues, which often results in painful intercourse. Sometimes if there is pain during intercourse, a woman will suffer involuntary spasms of the vaginal muscles (vaginismus) which causes more pain. This can lead to a vicious cycle where a woman fears pain, triggering involuntary muscular contractions, making the pain worse.
To summarize: for many women of menopausal age and beyond, the problem is not lack of interest, but pain or discomfort during sex, or the fear of that happening. The problem is primarily physical, not mental, and worry can make the problem worse. Fortunately, there are many ways to help.
To make sex more pleasurable
A woman with concerns about sexual pain, or vaginal or urinary symptoms that might interfere with sexual pleasure, needs to honestly discuss this with her physician, preferably a gynecologist or a doctor with special interest in woman’s health issues.
The principal author of the study also emphasizes that doctors need to be more aware of these issues, and to ask peri- and post-menopausal women about any difficulties during sexual relations.
A wide variety of treatments can help. The simplest is to use plenty of lubricant during sexual activity. Other measures include estrogen creams, hormonal replacement therapy, physical exercise, and pelvic floor exercises. If you have problems, see a doctor you trust. Note also that regular sexual activity brings more blood flow to the pelvic area, which improves vaginal tissue health. Don’t avoid sex if you want it. You deserve it, no matter your age.
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