Effective Treatments for Sexual Health Problems After Menopause

While more than 70% of postmenopausal women report their sex life is important to them and they want to maintain it, more than half complain of low libido (sex drive) and diminished sexual frequency. Pain during intercourse (also known as dyspareunia) can occur from Genitourinary Syndrome of Menopause (GSM) symptoms. Dry, thin tissue is prone to feeling irritated and burning that worsens with friction during intercourse. This can lead to bleeding, more pain and irritation, and a dampened desire to repeat the experience. Low libido can occur from other reasons as well, such as psychosexual, cultural, ethnic, religious, or personal beliefs, other health issues, or partner-related problems (or lack of a partner).

When low libido is unrelated to other treatable physical issues such as GSM, it is called Hypoactive Sexual Desire Disorder (HSDD). Here is a short list of five evidence-based treatments for sexual dysfunctions related to GSM and HSDD (and there are many more):

1. Intra-vaginal estrogen (estradiol) is very effective in reversing vaginal atrophy and restoring tissue health, especially if started soon after problems begin. Vaginal estradiol is a local menopause hormone therapy available in a pill insert, cream or a diaphragm-type ring insert. There is minimal systemic absorption with local vaginal estrogen, so it can be safely continued by most women for years after menopause who don’t have contraindications.

2. Intravaginal dehydroepiandrosterone (DHEA) (prasterone) may be more helpful than vaginal estrogen if low libido is present. DHEA is an androgen that converts to both estrogen and testosterone in the vagina with minimal systemic effect. The added benefit of androgen conversion in local vaginal tissues stimulates sex drive. It has a good safety profile for most women who don’t have contraindications to estrogen therapy, although long-term safety studies are still underway.

3. Testosterone transdermal therapy at physiologic levels delivered via a patch may be effective treatment for HSDD unrelated to other treatable conditions. Because testosterone can become toxic at high levels, only transdermal application is recommended. It is too hard to monitor hormone levels in other formulations such as oral medications or injections.

4. Good quality lubricants with a pH close to the natural vaginal pH of 4.5 – 5.0 can relieve friction and reduce the risk of tears due to fragile tissue during intercourse. Avoid lubricants that contain harmful ingredients such as petroleum and alcohol, and stay away from products that heat up or contain colors.

5. Pelvic health physical therapy. That’s right, physical therapists (PT) who specialize in the evaluation and treatment of pelvic floor dysfunctions are the best-kept secret out there! A good pelvic PT can be very helpful in recovery from pelvic pain due to various causes and help manage distressful bowel and bladder problems affecting your sex life. They can also make recommendations for managing other menopause-associated problems to improve your quality of life!

Good sex doesn’t have to end after menopause regardless of the reason. Talk to your healthcare provider if you are experiencing problems affecting your quality of life.