Menopausal Intimacy - What's Sex Got To Do With It?

Many women reach menopause and wonder what happened to their sex lives. They feel a decreasing desire for vaginal sex but crave partner intimacy and trust. Sexuality evolves as we age. Intimacy is defined in this context by Webster's Dictionary as a close personal relationship marked by affection and love. It also has been used to denote sexual intercourse. Intimacy in menopause does not necessarily involve sexual intercourse.

Anthropologists tell us that the driving purpose of sexual intercourse is to reproduce the species. Humans are in a rare group of primates in their desire for sexual monogamy. The human desire for sexual intercourse and intimacy continues throughout the lifespan of men and women despite the fact that a woman's ability to reproduce rapidly declines after age 40 and ceases by about age 50.

Hormone blood levels, unfortunately, do not provide a clear picture of why sexual desire and satisfaction change over time for many women. Blood levels of androgens (testosterone, dehydroepiandrosterone sulfate [DHEAS], and androstenedione) decline by two‐thirds between age 30 and 70 reaching a lower but stable level during menopause. Unfortunately, women with low libido and those with normal libido can have similar levels. We do know that removal of the ovaries in premenopausal and perimenopausal women can precipitously cause many menopausal symptoms, including decreased desire. Some antidepressant medications also can reduce libido.

A recent AARP survey indicated that over 70% of baby boomers said sex was still important, and 54% were satisfied with their sex life. Yet, 76% indicated that sexual desire had declined in the past 20 years, and by age 75 to 85 only 16% of women and 38% of men were sexually active.

Many emotional changes impact intimacy and sexuality around the time of menopause. Children leaving home, elderly parents becoming more dependent, job stresses, and relationship stresses all can affect sexual feelings. Women, more than men, often need the right "frame of mind" to have increased desire and sexual intimacy. The willingness to become aroused occurs first, followed by sensing the emotion of desire, which can then usually lead to pleasurable sexual intercourse. Emotional and physical obstacles, however, can interfere anywhere along this path. Sexual dysfunction can result from any of the following symptoms: loss of desire, difficulty in arousal or orgasm, occurrence of discomfort or pain, AND personal distress about the problem.

At the end of the day, each woman needs to decide how intimacy and sexual intercourse fit into her life. For many, partner intimacy and sexual satisfaction are not defined by genital function alone but are complemented by friendship, loyalty, history, and trust. Is intimacy reflected by one's sexual activities or, instead, the unanticipated flowers for no reason, the hand that holds yours during the darkest moments of cancer therapy, or the comfort of knowing that the foot touching yours in bed late at night loves you for being you? You choose.

By James Woods, M.D. & Elizabeth Warner, M.D.
Dr. Woods treats patients for menopause at the Hess/Woods Gynecology Practice.

Disclaimer: The information included on this site is for general educational purposes only. It is not intended nor implied to be a substitute for or form of patient specific medical advice and cannot be used for clinical management of specific patients. Our responses to questions submitted are based solely on information provided by the submitting institution. No information has been obtained from any actual patient, and no physician-patient relationship is intended or implied by our response. This site is for general information purposes only. Practitioners seeking guidance regarding the management of any actual patient should consult with another practitioner willing and able to provide patient specific advice. Our response should also not be relied upon for legal defense, and does not imply any agreement on our part to act in a legal defense capacity.

James Woods | 11/4/2014

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