Is There Sex after Menopause?

Many women fear that they will lose their sexual interest and appeal at menopause, but according to recent surveys, more than two-thirds of women remain sexually active throughout life. A woman's attitude toward sex when she is younger is often a predictor of how she will feel later in life.

Diminished sexual interest during the menopause years is not unusual, however. Decreased testosterone production in older women and men is known to lessen sex drive, but low self-esteem can also be deadly. While counseling can help to dispel negative feelings about body image and aging, getting treatment to ease the physical discomforts of menopause can go a long way toward increasing sexual enjoyment.

Some women complain of pain during intercourse. As estrogen declines, the tissues of the vaginal lining become thinner and less elastic and vaginal secretions are less abundant. Using a lubricant or estrogen cream or HRT may remedy the problem. Health experts point out that remaining sexually active is the best way to maintain the healthy function of vaginal tissues.

Bladder problems are another common complaint. Declining estrogen diminishes muscle tone and strength in the pelvic area. One result can be the frequent urge to urinate plus a tendency to leak following a sneeze, cough, or burst of laughter.

Kegel exercises are a good way to strengthen the pelvic muscles. They also can enhance sexual enjoyment. Try squeezing and tightening the muscles that you normally use when urinating or having a bowel movement. The object is to squeeze and hold for several seconds, then release and repeat. The more you exercise, the better.

The HRT Debate

Susan Love, M.D., an outspoken advocate for women's health and a graduate of SUNY Downstate's College of Medicine, believes that menopause, like childbirth, is a natural process that has been over-medicalized. In her best-selling book, Dr. Susan Love's Hormone Book: Making Informed Choices about Menopause, she writes: "Now we talk about 'curing' or 'treating' menopause. If estrogen deficiency were really a disease, the doctors would have to declare all men chronically ill."

Arguing that "nowhere has the concept of preventive medicine caused more confusion than in the area of hormone therapy," Dr. Love accuses the drug companies of marketing "eternal femininity" and using the fear of heart disease and osteoporosis to steer women toward using HRT. She would rather see women engage in a healthier lifestyle that includes daily exercise and a diet containing less meat but plenty of vegetables and soy.

Many health professionals, however, believe that for women who are not at high risk of developing breast cancer, the health benefits of HRT in preventing osteoporosis, heart disease, uterine and colon cancer, and Alzheimer's disease are compelling reasons in its favor. Some recommend that women postpone taking HRT until they reach their mid fifties and sixties, when these health risks become greater.