Can you discuss how menopause might affect my sex life?

DEAR DOCTOR K:

I have recently entered menopause. Can you discuss how menopause might affect my sex life?

DEAR READER:

As a woman approaches and enters menopause, her ovaries gradually make less and less of the hormones estrogen and progesterone. The drop in these hormones — of estrogen in particular — can affect how a woman experiences sex.

Estrogen stimulates the growth of breast tissue. It maintains blood flow to and lubrication of the vagina. The decline and eventual end to estrogen production provokes a host of symptoms. These include hot flashes, fatigue, vaginal dryness and loss of libido. Many of these changes can have unwanted effects on a woman’s sex life.

Other physical changes also take place, to varying degrees, as a woman enters menopause. For example, as a woman gets older, blood flow to her genitals decreases. She will experience a thinning of the vaginal lining. Her vagina will lose muscle tone and become less elastic. These changes can make sex more painful and less enjoyable.

A woman may have less sexual desire, or fewer sexual thoughts and fantasies. It may take longer to become aroused. She may have less vaginal lubrication and less expansion of the vagina during arousal. Less blood will enter the clitoris and lower vagina, and the clitoris will become less sensitive.

Orgasm may become less certain. It may take longer to achieve orgasm, or it may not occur at all. When it does occur, it may be less intense. Finally, as a woman gets older, she will return more quickly to an unaroused state.

Does this mean the end of a fulfilling sex life? It certainly doesn’t have to. For some older couples, fewer inhibitions and a deeper understanding of their needs compensate for the physical consequences of aging. And these physical changes can provide an impetus for developing a new and satisfying style of lovemaking — one that’s based more on extended foreplay and less on intercourse and orgasm.

If certain positions cause pain, see if you can experiment and find positions that don’t. Women who have sex on top of their partner often are better able to control the force of the thrusts that cause pain — and thereby reduce or eliminate it. In addition, slower, more relaxed foreplay can encourage more vaginal lubrication.

The physical changes can be reversed or reduced with vaginal lubricants and moisturizers, or hormone therapy (cream, not pills). Estrogen cream applied to the vagina is effective in improving vaginal lubrication. An advantage of the cream, compared to estrogen in pill form, is that the estrogen remains largely in the vagina and doesn’t travel in the blood to be carried elsewhere in the body.

When the main problem with sex is a lack of sexual desire, testosterone therapy can sometimes help improve a woman’s desire. Even though we think of testosterone as a male hormone, it is naturally made (in smaller amounts) by women and increases sexual desire.