Sexual Dysfunction / Dryness

The women losing interest in sex had water retention, fibrocystic breasts, depression, dry wrinkling skin, and irregular and sometimes heavy periods I gradually came to understand that these signs and symptoms were indicative of a progesterone deficiency caused by a failure to ovulate while estrogen continued to be produced, which is to say loss of sex drive correlates with progesterone deficiency, not estrogen deficiency. Women on estrogen replacement therapy coming to me for treatment of the osteoporosis also confided in me that they were unhappy with the fat accumulating at their hips and abdomen, their swollen breasts, and their loss of sex drive. Estrogen replacement had not restored their previous sex drive. When these women used the progesterone cream supplementation I recommended, the stories changed: they were delighted to report that their sex drive had returned.

It is clear that, in most female mammals, the rise and fall of sex hormones coordinates sexual behavior so that mating is most likely to occur near the time of ovulation. This, after all, is the primary function of sex drive. This study shows that sex drive is a function of both estrogen and progesterone, and probably also of testosterone. The administration of estrogen in the absence of progesterone does not accomplish stimulation of sex drive. In humans, estrogen production falls only 40 to 60 percent at menopause, whereas progesterone falls to close to zero percent when ovulation no longer occurs. This explains the loss of sex drive in pre-menopausal patients with estrogen sufficient for monthly periods (and in postmenopausal women in ER) but lacking in progesterone and the resumption of normal sex drive when progesterone was added.

Among many researchers testosterone is given credit for being the hormone attached to sex drive in both males and females.  It is widely assumed that the increase sex drive in fertile women correlates with a timely spurt of testosterone.

It is important to be reminded again of the complex interplay and delicate balance of hormones in the human body and the difference between taking physiologic and pharmacologic does of hormones. Physiologic (equivalent to normal body function) doses are meant to be replacement doses for a specific hormone deficiency. They are not meant to exceed normal bodily production and they promote no abnormal actions in the body. Pharmacologic (drug) doses, on the other hand, are considerably greater than normal production, but also to actions different from those found with normal hormone  levels. In this case of progesterone, pharmacologic doses may actual inhibit sex drive whereas physiologic doses stimulate sex drive. In my practice, I recommended a progesterone cream that supplied only about 15 to 30 milligrams per day, stimulating normal progesterone production.”

If you are experiencing lack of sex drive, it is important to get your hormone levels checked to evaluate what you have and what you need on a very individual and personal level.

Excerpted from "What Your Doctor May Not Tell You About Menopause" by John R. Lee, M.D. and Virginia Hopkins, www.johnleemd.com.

SEXUAL AIDS

Look for things that spark the passionate side of you. If you are on antidepressants and hormones, controlling and navigating your sexual feelings are your personal challenge. You may not be unable to get there because your libido is suppressed. Get out of park and start moving your sex life again. You are The Little Engine That Used To. Become the Little Engine that Purrs.

Create intimacy that ignites your passion by putting yourselves in a new situation that reveals a new side to one or both of you. The treasure trove of years together can be a jumping off point for both of you. Look in the mirror and see your best self.

LACK OF SEX

Whether you are in a long term relationship, or you are alone, you need some private experimentation. Your body has changed. You need to experiment with what feels good now. You may even surprise yourself with how you respond to new stimulation. New places of ignition now exist in your body. If you respond to the same old in the same old way, it lacks luster. You need sexual stimulants that you can explore in the privacy of your own mind and bedroom.

Alone or in a relationship, you may not be faced with the opportunity of sex or you may be experiencing a dry spell period. There is a use it or lose it attribute to the vagina. Consider tools that will open you up vaginally to avoid the pain that comes from these dry spells.

1. dildos that are soft and pliable
2. creams and salves to moisten the entry
3. antiseptic lubricant to kill germs on entry and prevent infection
4. antiseptic lubricant that kills the AIDS virus or prevents herpes before its onslaught

SEX/ Loss of Libido

Menopause may also put you in a state of little or no production of testosterone. This hormone is responsible for your sense of well being, your sexual interest and your general level of energy. I know why the caged bird sings. One researcher, curious that only the male canaries sing, gave testosterone to the female canary and she burst into song. He was able to trace this change to increased stimulation of an area in the front part of the brain of the canary. Research on humans has demonstrated that testosterone receptors are concentrated in those areas of the brain involved in sex and emotions. Without testosterone, we would have no public hair, no sensitivity to sexual pleasure in the nipples or genitals, and no receptivity to the sexual aspect of falling in love --- no capacity to turn on.

The amount of testosterone, tiny as it is, that a woman’s body is continually producing is an essential amount. If your testosterone drops below the critical point for you, you will notice a loss of vital energy and feeling of well being. You will experience a loss of your familiar level of sexual desire, your nipples and genitals will become less sensitive and your public hair might become thinner in texture and sparser. You will experience a flatness of mood and might notice some loss of mental sharpness. You might develop dry skin and brittle scalp hair. You will notice some loss of muscle tone. Other effects of testosterone deficiency can include decreased production of red blood cells by bone marrow and loss of calcium from bones, which can contribute to osteoporosis.

Testosterone deficiency may also contribute to the loss of muscle tone in the bladder and pelvis, resulting in symptoms of urinary incontinence. Women who need and use supplementary testosterone, conceivably in conjunction with Kegel exercises (contracting and relaxing inner pelvic muscles), have a maximum opportunity for maintaining bladder sphincter tone.

In the same way that estrogen deficiency is an aspect of normal menopause, we could say that testosterone deficiency is an aspect of normal menopause and aging. The fact that it is a normal part of the aging process however, does not mean that it should be ignored any more than should the gradual onset of osteoporosis or any other treatable condition.

If you have these symptoms, it’s a good idea to request that your physician evaluate all your hormones at this time. Ask for your hormone evaluation and discuss your scores with your doctor.

Testosterone can be created in a compounding pharmacy. Compounding pharmacies are strictly prohibited from manufacturing (making and storing in large quantity) their formulated pills, creams and other preparations. They are also required to use only ingredients that “comply with the standards of an applicable United States Pharmacopoeia or National formulary monograph.” These are licensed pharmacies able to make individual prescriptions formulated to order on prescription of a physician.

Estratest is a pharmaceutical preparation that includes estrogen and testosterone manufactured by Proctor & Gamble Pharmaceuticals. Because it combines two hormones in the same formula, it is often prescribed at half strength and doesn’t respond to the exact dosage that you may require.

A woman with an intact uterus who uses both supplementary estrogen and testosterone must take the same responsible steps as a woman using estrogen alone to develop a regimen of adequate progestin and to be examined by her doctor to avoid additional risk of endometrial cancer.

SEX / Lack of Libido

Sex is a function of your mind as well as your body. Attitude and desire come from within you. If you are alone or if you are with a partner, sex and sexual fulfillment are still within your grasp. The testosterone will help and kegel exercises can keep you physically receptive to insertion by building muscle base.

 I have used as a resource, "The Hormone of Desire: The Truth About Testosterone, Sexuality, and Menopause" by Susan Rako, M.D., a book that is recognized as providing the most comprehensive and clear information about testosterone deficiency and supplementation for women in the menopause.

HOW TO DO KEGEL EXERCISES

Strengthening the pelvic floor, muscles surrounding the opening of the vagina, can help to intensify arousal and orgasm and bladder control. It will allow you to grasp the penis better, heightening arousal for both you and your partner. Yoga and Pilates also help strengthen the pelvic floor.

1. Identify the pelvic floor muscles by clenching as though to stop urination in midstream. These are the muscles you need to exercise.
2. Practice by stopping and starting the flow of your urine.
3. When you are not urinating, practice contracting the muscles. You can do this anytime and anywhere since no one will be aware of what you are doing. You can do it lying down or sitting down, or standing up.
4. Start by contracting your vagina for 2 or 3 seconds, repeating 10 times.
5. Do at least 5 sets, or 50 contractions a day.
6. As your muscles strengthen, extend your contractions to 8 to 10 seconds. The longer you hold the contraction, the more effective the exercise, and the stronger your muscles will become.

How to Enhance Your Sexual Arousal and Pleasure in General

The first task is to let go of a goal oriented approach. Try not to focus on the orgasm as the end point. Focus instead on sensuality. Specifically try to enhance awareness of your other erogenous zones—lips, eyelids, inner thighs, buttocks, back, neck feet, ears—with touching, kissing, erotic touch, and light message. Often when we let go of orgasm-focused or intercourse-focused sex, the act becomes much more a reflection of intimacy, connection, eroticism and arousal. Sex can be more fun with much less pressure to perform. If a woman becomes anxious when a sexual experience begins, worrying that she wont be able to reach orgasm, it is likely that her body will respond to her anxiety, her blood vessels will constrict, and her arousal will diminish. Make sure that you keep the lines of communication with your partner open. Allow yourself the luxury of fantasies. Don’t be ashamed of your fantasies and try to be creative. Having a fantasy and acting one out are two different things. Use lubricants. In safer sex, lubricants should be water-based, like KY Jelly, Astroglide, and Foreplay. Vaseline, baby oil, and Crisco can break down the latex in condoms. Nonoxynol-9 is a spermicidal lubricant on many condoms that is widely believed to kill HIV. However, according to a study presented at the 13th annual AIDS conference, women who consistently used Nonoxynol-9 nearly tripled their risk of infection, so you should discuss this option with your doctor. Try different kinds of sex toys or foodstuffs. Some couples like to use whipped cream, chocolate sauce, or honey. Others like to engage in light bondage play. Try fur lined Velcro handcuffs, silk eye masks, feathers, and videos and array of kits for tantric and other sex play. Try aromatherapy. Some oils also induce warmth and tingling that may accentuate arousal. Pay attention to your environment. Many women are context-oriented and need to feel comfortable and safe before they can enjoy sex. Take a bubble bath, light a candle, put on soft music. Some women like to wear lingerie to help them get into a sexy mood. Many women need a transition period to let go of all the stress in their lives before they can relax and turn their attention to their sexuality. A woman needs to see sex as part of taking care of herself, not just something she does for her partner or her relationship.

Vaginal Dryness

Estrogen and testosterone cream

If you need help with lubrication and sensation, consider adding the cream to the hormones that you are taking. Estrogen in the form of estradiol does get absorbed into the body, so consult your doctor and consider this in the computation of how much estrogen you need. The cream available as Estrace or Premarin, is applied with an applicator directly inside the vagina once a day. Because the amount of estrogen absorbed by the body can be significant, women with a history of blood clots or breast or endometrial cancer should not use the cream. Women who only have symptoms of vaginal irritation and /or dryness should consider Estring or Vagifem, which deliver a continuous low dose of estrogen locally to the vaginal tissue.

Testosterone cream is applied in a small amount to the clitoris and inner labia to help improve sensation. It also helps build up thin, atrophic genital tissue. The cream is highly effective in increasing genital sensation in women during sexual stimulation and intercourse.

The testosterone cream should be applied three times a week at bedtime and half an hour before sex if it doesn’t fall on one of those days, in carefully dispensed amounts. Using too much can result in increased genital hair growth or an enlargement of the clitoris.

 Excerpted from by Jennifer Berman, MD, and Laura Berman, PhD, For Women Only, Holt and company 2001.

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