Sex and the Mature Woman

Abstract

Menopause is associated with myths about the death of sexual vitality. While menopause causes many women to experience vasomotor instability, problems with osteoporosis, urogenital aging, and increased risk of heart disease, these issues can now be addressed with hormonal replacement strategies or alternative therapies. The menopausal woman today can be relatively comfortable with regard to direct menopausal symptoms of estrogen deficiency as a result of medical therapies. Sexual health and intimacy should also be considered in a holistic approach to the menopausal patient. The mature or postmenopausal woman need not abandon sexual intimacy. This review article presents information about sexual health in woman who are perimenopausal or postmenopausal. It explores a variety of medical, psychiatric, and psychological factors that can lead to either sexual health and comfort or sexual dysfunction and dissatisfaction. Given the benefit of good health, a loving relationship, and appropriate medical care, sexual vigor can continue in the mature years of a woman's life.

Classification, Etiology, and Key Issues in Female Sexual Disorders

“…Psychiatric co-morbidity impacts sexual function to different degrees in each individual, with past sexual trauma, eating disorders, or histrionic personality disorder [54][55][56][57][58] having some impact on sexual function. As many as 70% of patients with depression report a decline in libido [59].…”

Sexuality and Perimenopause: What Counselors Need to Know

“…This decreased desire has been attributed to hormonal changes such as androgen deficiency (Guay, 2001;Levin, 2002) and poor physical fitness, along with psychosocial factors such as decreased self-image or feeling sexually unattractive (Morokoff, 1988;Myskow, 2002) and depression (Maartens, Knottnerus, & Pop, 2002;Myskow, 2002). Although there is general agreement in the literature regarding decreased desire being a salient perimenopausal symptom (Berentsen et al, 2001;Li et al, 2000;Myskow, 2002), Pariser and Niedermier (1998) reported that "studies of sexual function among perimenopausal and menopausal women do not demonstrate evidence of specific sexual dysfunction, such as delayed orgasm or loss of sexual desire" (p. 850). A full exploration of any changes in sexual desire is still warranted by therapists working with these individuals.…”

“…Discomfort from insertional dyspareunia (i.e., pain during vaginal penetration) and occasional painful uterine contractions with orgasm, which occurs in some perimenopausal women, also affect the excitement and orgasm phases (Gelfand, 2000;Li et al, 2000;Sarrel, 2000). These changes not only adversely affect sexual desire but can also lead to a decrease in sexual activity (Capuzzi, 1982;Myskow, 2002;Pariser & Niedermier, 1998).…”

“…Pariser and Niedermier (1998) reported that no evidence existed for orgasmic dysfunctions, whereas Gelfand (2000) reported fewer and occasionally painful uterine contractions with orgasm as one of the perimenopausal changes seen in sexual response. However, Leiblum and Segraves (1995) changes are evidenced by fewer contractions and decreased intensity of the contractions during orgasm, not impairment of the response itself They also suggested that the anatomical changes, such as decreased lubrication and less elasticity of the vagina, adversely affect the ease and comfort of sexual exchange; therefore, the orgasmic response is affected but not impaired.…”

Dimensions of Sexuality in the Perimenopausal Transition: A Model for Practice

“…It is an amalgam of biomedical and psychosocial models, yet has added focus on culture. This model takes a holistic approach to sexual health, which is recommended by researchers and clinicians engaged in the study of midlife women (Pariser & Niedermier, 1998). It was originally outlined by Lee and colleagues (1994) as a way to examine the perimenopausal experience.…”