BoomerGirl Diary

Dear Crabby:

What can I do about my libido? I used to be a hot mama and now I'm more like a cold fish. I tried to discuss this with my doctor, and he handed me a free sample of Viagra, which I never took any of because it scared me. There must be something that would bring back that old desire in me. I am getting kinda desperate thinking my hubby will look elsewhere if he doesn't get any from me. He made the comment, "I can see why some husbands leave their wives during menopause." He reassures me that he never would leave me or have an affair, but I am concerned. Thanks!

Sewandsew, Kan.

Dear Sewandsew:

I’m always telling women in my practice that there ought to be “Team Menopause” T-shirts that feature our motto: “I’m fat, I’m tired, and I don’t want any!” These seem to be the top three complaints I hear from my patients. You are definitely not alone. We’ve all heard that “a woman’s sexuality peaks around age 40,” but I’d be hard pressed to buy that given what my patients have told me in the last seven years. One of two things must be true: Either that is a vast overgeneralization, or the “peak” lasts about 5 minutes and then we plummet at top-speed into an abyss of sexual malaise. I’m betting on the former.

Despite the irritating stereotypes of midlife women as either sexless bores or hot-to-trot femmes fatale, midlife sex is a really complex issue, and most women fall somewhere in between. Indeed, our “lust levels” can even change from day to day.

Our physical health, the health of our relationships, our hormonal status, our emotional health and our stress levels all play a role. And that T-shirt slogan above is also revealing. How we feel about our own bodies, as well as our personal energy levels does affect our desire for sex. Some of these factors are more easily addressed than others.

There are several key questions that I believe are important here. The first is “Whose problem is it?” If it’s a problem for you, (you want to have sex more, miss it and wish your former lusty self was still around) then it is a problem. If you’re ok with your level of sexual activity, and the problem is primarily your partner’s unmet sexual needs, it becomes more of a relationship issue. If your husband or partner would really leave because of lack of sex, assuming other forms of intimacy are available, there are probably other issues in the marriage that need to be addressed.

It’s also helpful to examine the flipside of this issue: for example, what if he suddenly became impotent? Would you say to him, “Wow, I can see why a lot of wives leave their husbands in old age?” Or would you support him and find other ways to achieve sexual satisfaction, both together and separately? This is a handy analogy to whip out during these conversations ...

The second question is “Was your sexual life previously satisfying, frequent enough for your personal needs, and orgasmic? And if so, did this change mainly due to menopause?” This is helpful because there can be a number of other reasons for sexual desire to decline, as mentioned above.

The third question is “Do you have sexual thoughts about other people (not your current partner)?” or do you really lack sexual thoughts and fantasies? If the former is true, it is less likely to be a physical issue.

In terms of some of the other issues: Do you have physical problems like back pain, arthritis, or vaginal dryness that make sex uncomfortable? Could you be depressed? Have you become out of shape and embarrassed to be naked? Do you set aside time for intimacy, or is your life a treadmill of chores, tasks, and thankless jobs? These questions may also apply to your partner.

Is your husband/partner attentive, treating you as an equal? Do you have long-standing relational issues that are finally coming to a head now that you have reached menopause and have decided that you just aren’t going to take crap from anyone anymore? Is your partner’s idea of foreplay rolling toward you in bed? In other words, does your relationship resemble that of:

• Paul Newman and Joanne Woodward — married almost 50 years and loving it, (He famously said, when asked about extramarital affairs, “Why go out for hamburger when you have steak at home?”)

OR

• Kathleen Turner and Michael Douglas in “War of the Roses?”

These are all issues you need to tackle, if they are present.

Women’s sexuality, researchers are finding, seems to be more cognitive/emotionally-based than men’s. As one study put it, for men, erection=arousal and readiness for sex. For women, even when blood flow is increased to the genitals (the female equivalent of an erection, without the tell-tale bulge), women don’t always report arousal. This is why, for example, the drug Viagra®—which increases genital blood flow—has had disappointing clinical trials for women. Most women can relate to this ... if we are stressed or preoccupied, it is harder for us to feel sexual, or if we are distracted by something, (like, say, a teenager knocking on the bedroom door) it’s an immediate moodkiller.

A big part of the current thinking today is that postmenopausal women lose libido due to a drop in hormone levels, especially testosterone. Although testosterone is traditionally thought of as a male hormone, is in fact also produced in the ovaries, which after menopause are mainly ornamental. Therefore, many health care providers prescribe topical testosterone creams, to be applied to the vulva and clitoris several times a week. This cream can be part of a combined regimen of hormonal creams, as in bioidentical compounded hormones, or a stand-alone therapy. For many women, this is effective, and at appropriate doses, does not result in becoming excessively manly, i.e., sporting a beard and refusing to ask for directions.

For women who are taking HRT, there is a combination estrogen-testosterone pill available. (Women who still have a uterus would also need progesterone.) This has worked well for many women, if they are inclined to take traditional HRT.

Some providers may also prescribe an antidepressant called Wellbutrin®, which seems to perk up the libido for some women. These are the primary pharmaceutical treatments I see and use in practice. You will need to see a healthcare provider for these, as they are only available with a prescription.

There are some widely advertised herbal or supplement type-products out there, which need to be assessed by your provider for safety and interaction with your current medications. There is also a medical device called Eros® that essentially provides suction, and, in turn, increased blood flow to the clitoris. According to its manufacturer, regular use (i.e., during non-intercourse occasions) has increased libido overall. This is the female answer to the penis-enlarging pump. However, given the limitations above regarding Viagra, it is unclear if this will work on a consistent basis. And who wants your kids finding your clitoral pump after you’re dead or during a wild but illicit teenaged party when you’re out of town? (“I can’t believe my mother even has a clitoris. I need immediate, long-term therapy!”)

Part of the problem is just that, well, in any long-term relationship, sex can become boring and routine. There are a number of guides out there related to improving sexual relations in marriage, and despite also being something you don’t want your kids to find, (“Eeew! Mom and Dad still ‘do it’—gross!”) these guides offer some helpful suggestions. (“Why, hello, pizza delivery boy ... your tip is hidden somewhere on my body ... think you can find it?”)

So basically what I recommend is a good physical examination and discussion with an interested clinician (easier written about than found, as you’ve alluded to) as a start, and perhaps marital therapy if this is really about anger, power, and unresolved feelings.

One more thing before I go ... please don’t feel this is all a mid-life women’s problem: I am hearing about these problems from young couples and gay couples, as well as from men who have libido issues and the women who pine for them ... is it stress? Environmental toxins? Unrealistic movies that make us believe we should all be gorgeous, hot and sexy until they load us into the casket? WHAT? If I find the answer to that question, dear readers, you’ll be the first to know.

Perhaps someday, scientists will figure out how to package the endorphin rush that goes along with a new relationship—that period when you can’t keep your hands off one another—and put it in a patch for menopausal women. Heck, for all of us. Until then, we’ll have to do what we can to care for our health, our relationships, and our collection of Johnny Depp DVDs. If a gal needs an aphrodisiac, she could do worse than Johnny. Sigh.