Menopause initiates a change in sex drive for many women. From a purely biological perspective, it makes perfect sense for a woman in midlife to lose interest in sex. After all, she’s not going to be making any more babies. Her body doesn’t know about the many ways to prevent pregnancy, so it does what it can — it shuts down her sexual drive. But humans are not pure biology. We are thoughtful, caring, social beings. We need and want loving relationships for the intimacy and connectedness they offer, not just for the biological purpose of reproduction.

Androgens and Sex Drive

While estrogen takes the heat for most of the changes associated with menopause, the focus shifts to androgens when it comes to libido. We generally think of androgens as the “male” hormones, but the bodies of both men and women produce androgens (as well as what we think of as the “female” hormones, the estrogens). The most common and familiar androgen in both male and female bodies is testosterone. In the male body, this is the hormone responsible for secondary sex characteristics such as facial and body hair. The male sex glands, the testes (also called testicles), produce most of a man’s testosterone. His adrenal glands produce smaller amounts of testosterone and other androgens, as well as minute amounts of estrogens. (Researchers don’t fully understand the role of estrogen hormones in the male body.)

In the female body, the ovaries and adrenal glands produce very small amounts of androgens, predominantly androstenedione and testosterone. Androstenedione is called an estrogen precursor — from it, a woman’s body makes estrogen. Estrogen — more specifically, the estrogen hormone estrodiol — stimulates androgen production. So, there’s a tight circle connecting these hormones in a woman’s body. When one changes — for example, estrogen production declines as follicle activity diminishes — it affects the others.

Androgens are the hormones responsible for secondary sex characteristics in men and libido in both genders. Libido is a person’s sex drive or interest in sexual activity.

At menopause, a woman’s testosterone level drops by half or more. Many doctors believe that this is responsible for signs such as lack of interest in sex and perpetual tiredness or fatigue. When a woman’s testosterone levels are low, hormone replacement therapy that includes a tiny amount of testosterone supplement can often help. Some research suggests that testosterone supplementation aids estrogen in building bone and reducing the risk of osteoporosis.

In the human body, testosterone exists in two forms: free and bound. Both are important when trying to determine whether low testosterone is responsible for a woman’s low libido and other problems. Most of the testosterone is bound, or attached to proteins in the blood. The testosterone that’s not bound is free and is the testosterone that influences a woman’s sex drive and energy levels. Blood tests to measure testosterone can measure total testosterone and free testosterone. It’s possible (and surprisingly common) for a woman’s total testosterone level to be normal and her free testosterone level to be low, causing symptoms.

Other Hormonal Influences

Changing estrogen and progesterone levels cause changes in vaginal tissues and lubrication that can make sex suddenly and markedly less enjoyable — and even painful. The body’s natural secretions become less abundant, and a woman’s genitalia can feel dry and irritated. Sexual arousal can take longer, too. Over time, vaginal tissues can become thinner and less resilient as well. At the risk of sounding crass, the best cure for these changes is frequent use! Women who engage in sexual activity (including masturbation) often and regularly are far less likely to experience drastic changes in vaginal tissues.

Viagra for Women?

When Viagra (a brand name for the impotency drug sildenafil) hit the market in the late 1990s, millions of men with erectile difficulties swamped doctors’ offices with requests for this miracle in a little blue pill. Viagra increases a man’s ability to get and maintain an erection. To understand how Viagra works, you need to understand how an erection happens.

When a man becomes aroused, smooth muscle tissues such as those in the walls of the penis produce the chemical nitric oxide. The increased level of nitric oxide causes the release of another chemical called cyclic GMP. Cyclic GMP allows the muscles in the penis to relax so that the erectile tissues can fill with blood. This causes the penis to become enlarged and firm. Because a permanent erection is much less desirable than it might sound (without fresh blood to bring oxygen, the tissues would die), the man’s body also produces a chemical called PDE5. PDE5’s mission is to counteract nitric oxide to reduce the flow of cyclic GMP. As cyclic GMP drops, so does the erection. Viagra works by slowing the production of PDE5. Less PDE5 means that the level of nitric oxide stays higher for longer, and so the penis stays firmer for longer.

People who are taking nitrate-based medications commonly prescribed for heart conditions such as angina should not take Viagra or similar products. Taking two nitrate-based drugs at the same time can cause the blood vessels to dilate throughout the body, resulting in a sudden drop in blood pressure.

Very interesting, but just what does this have to do with women, you ask? Well, the tissues of the clitoris are the same tissues as those of the penis. While there haven’t yet been extensive tests of Viagra use in women, there is considerable speculation that what’s good for the gander is also good for the goose. A few small studies have shown that Viagra does in fact have the same effect on the clitoris and the walls of the vagina as it does on the penis: increased blood engorgement. This appears to heighten sensitivity, making sex more pleasurable and enabling women to more easily achieve orgasm. As of this book’s writing, however, Viagra (which requires a doctor’s prescription) is not approved for women to use.

Is your relationship struggling? Midlife is a challenging time for many reasons. A therapist who specializes in relationship issues can help you sort through your feelings, worries, and concerns. Your regular doctor or health clinic can refer you to a therapist who is qualified and appropriately licensed.

Beyond Hormones

Decreasing hormones aren’t always to blame for diminishing libido. Sometimes issues within a relationship interfere with sex drive. It’s difficult to feel romantic when financial or career challenges preoccupy your thoughts. Some couples lose sight of what holds them together during the years when raising children takes over their lives, and then they don’t know how to relate to one another when the kids leave home. Some partners haven’t really gotten along for quite some time, but they have been able to hide from the reality until their relationship confronts a life junction such as menopause.

Beyond its role in reproduction, sex is the most intimate communication between two partners. When the elements of intimacy are lacking, interest in sex often drops off. Menopause, as a time of life when it’s natural to reflect and evaluate your life, can also be a time when intimacy issues come to the surface.

Lack of interest in making love reflects these struggles more so than sex drive (hormones). If your interest in sex seems low and your doctor can’t find a physical reason, or if medical therapies such as hormone replacement therapy don’t help, consider seeking advice from a couples’ therapist. This can focus a more objective spotlight on your concerns and feelings.

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