For women, changing hormone levels, changing bodies, changes in relationships, stressors and family dynamics can all affect libido and sense of sexual wellness. This happens, not only during the transition into perimenopause and menopause but during her pre-menopausal years as well.
If experiencing a change in libido, it’s important to first recognize that the reason for it can be multifactorial, and that it is not always just hormonal. It is also important for each woman to evaluate what this means for her and know that each is an individual with different needs.
Many factors can impact a woman’s sexual desire, enjoyment of intercourse, and ability to achieve orgasm. These factors can include stress, fatigue, lack of privacy, medical conditions, medication, relationship difficulties, and hormonal changes, among others.
It is important to note that not all sexual problems come in form of low desire. Sexual health can be broken down into four sections: desire, arousal, enjoyment (orgasm related), and comfort/pain. Each woman’s struggles are different and do not always fit in the same box as their co-worker’s or friend’s but will still have an impact on their sexual health.
Some women are faced with hypoactive sexual desire disorder, which is a recurrent deficiency or lack of sexual thoughts, fantasies, and/or interest that causes personal distress. This is a complex syndrome that can be due to hormonal imbalances, psychological factors or both. Many people realize that as they become busier, more stressed and overwhelmed, it influences their sexual desire. For most it leads to a decrease in sexual desire, however, for some, it can increase desire. Both may cause personal or relationship issues, and it is important to note that neither is the right or wrong response. Sexual health, and especially desire, is unique to everyone.
During menopause (including surgical menopause) women often experience a change in both sexual desire and arousal due to decreased levels of hormones. Often times even if the desire is present, there is an inability to attain or maintain sexual excitement and there is a lack of response to sexual stimulation (such as lubrication). A woman’s hormones, particularly estrogen, are responsible for the health and lubrication of her vaginal tissue, and as hormones change vaginal dryness and atrophy can cause distress. Treatment options for this include but are certainly not limited to hormone therapy.
For many women, it is not a lack of interest but rather a fear of pain affecting their sexual health. For those where pain and muscle spasms are associated with intercourse, vaginal wall exercises that strengthen or relax the pelvic floor muscles can be helpful. This is often where a pelvic floor physiotherapist can be a great resource. As mentioned above, a woman’s hormones are responsible for the health of her vaginal tissue. As the hormone levels decline, the vaginal walls become thinner and less elastic, combine this with a decrease in lubrication and the vagina becomes far more prone to injury from penetration (proper lubrication is key).
It should also be acknowledged, that women may avoid intercourse due to future discomfort or pain, such as chronic recurrent UTI’s and other infections or concerns that arise after intercourse. Prevention is key in these situations including hygiene, potential supplements and we cannot forget the microbiome of the vagina and urinary tract.
In relation to medicine, woman’s sexual health is a relatively new field. For many years, women’s sexuality and sexual challenges were addressed and treated similar to men. As more research into woman’s sexual health and woman’s health in general emerges, we are constantly learning how to better address these challenges.
Sexual health is unique to each individual and though it may not be commonly discussed it does play a role in a woman’s overall wellness, and should be addressed with your physician if you have any concerns. Many women have challenges in regards to their sexual health and wellness, and the treatment needs to be unique to not only their concern but also their goals.
By Dr. Brittany Schamerhorn, ND
Balance Medical Center