Menopause or climacteric is defined as permanent cessation for more than twelve months of menstruation due to the loss of hormonal activity (estrogen) in the ovary.
- 1 Menopause and sexuality
- 2 Types of sexual disorders in menopause
- 3 Treatment of sexual disorders associated with menopause.
Menopause and sexuality
Associated with the hormonal changes of this stage there are a number of stressors that can influence the sexual deterioration of women, such as the age of the relationship and previous sexual experience, age, if there are physical problems or mental, health and medication use, loss of partner. In addition, changes also occur at the physiological level, since at this stage there is a reduction in hormonal production both at the ovarian level and the adrenal glands. The lower number of estrogens affects the reproductive and neurovegetative system, causing hot flashes, sweating, sleep disturbances, fatigue, vaginismus, cystitis.
The effects of estrogen reduction at the sexual level can be divided into:
- Anatomical changes at genital level: Atrophy with decreased elasticity of the vaginal epithelium, decreased lubrication and urogenital atrophy. Decreased clitoris size and thinning of the labia majora
- Changes in sexual response. Lengthening of the excitation phase, decreased orgasmic capacity, decreased muscle tension and reduced erection of the clitoris
- Psychological changes: Mood swings, loss of desire, aversion to physical contact. Here it is important to highlight the influence of social myths and the level of education that ridicule the sexuality of older people and that can significantly influence the mood of women. Laumann in a study published in 1999, related the level of education and the enjoyment of sexuality after the climacteric concluding that, the less education the less enjoy sexual intercourse.
With regard to psychological changes, it is where we see greater individual variability; for some women reaching menopause or climacteric, it is a liberation and they may experience feelings of happiness by not having to worry more about the period or using contraceptives, but for others, however, hormonal fluctuations and physical changes can lead to mood swings, sadness, irritability, memory difficulties and even depression.
It is important to take these variables into account when explaining how the arrival of the climacteric can affect sexuality. We cannot doubt that satisfactory sexual activity is considered an important aspect of individuals. This is produced by the combination of biological, psychological and cultural factors
Types of sexual disorders in menopause
- Hypoactive Sexual Desire (especially the reduction of the desire phase and loss of libido),
- Dyspareunia and less lubrication due to vaginal atrophy
- Secondary anorgasmia
We will briefly define each of them:
a) Hypoactive sexual desire: also called “lack of sexual desire”,“ Sexual apathy ”or“ lack of interest in sex ”, refers to those people who do not have sexual appetites with lack of interest in any type of sexual behavior.
b) Dyspareunia or coitalgia: It is the painful sexual relationship. It covers from postcoital vaginal irritation to deep pain. It is defined as pain or discomfort before, after or during sexual intercourse. In menopause the main cause of dyspareunia is vaginal atrophy.
The Vaginal atrophy is commonly associated with the decrease in estrogen levels that accompanies menopause and aging. The decrease in estrogen levels is also related to atrophy of the vulva and lower urinary tract, commonly referred to as urogenital atrophy. This happens because the vaginal surface thins and although the sebaceous glands remain prominent, their secretion decreases and the onset of lubrication during sexual intercourse is delayed.
c) Secondary anorgasmia: it is the recurrent and persistent inhibition of orgasm, manifested by its absence after a normal excitation phase, and produced through a stimulation that can be considered adequate in intensity, duration and type. After a time of having had orgasms normally, stop experiencing them systematically.
Treatment of sexual disorders associated with menopause.
Above all it should be a comprehensive treatment. It would be essential to include basic aspects of education and sexual functioning, medical management of symptoms or problems that interfere with desire or sexual activity and be able to act on physical and psychological problems as a couple.
The woman and her partner have to know what When menopause arrives, more time is needed to reach the excitement phase and the vagina begins to lubricate. Vaginal dryness can make intercourse painful or at least uncomfortable, and the prospect of a sexual relationship conditioned by this fact can cause a woman to lose interest in sex. The solution in this case is simple: take more time for stimulation and use lubricating gels, always seeking full satisfaction.
Another change that occurs with the menopause It is the loss of pelvic floor muscle tone, which, together with vaginal dryness, makes contractions that occur during orgasm less intense and lasting. In this case, the pelvic gymnastics It will help the woman to maintain control of these muscles and with it the intensity of her orgasms.