Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, May 14, 1990 TAG: 9005120230
SECTION: EXTRA PAGE: E6 EDITION: METRO
SOURCE: Jane E. Brody
DATELINE: LENGTH: Medium
Chances are these long-term concerns have overshadowed the much more common and more immediate effects of menopause: the toll that declining estrogen production can take on a woman's sexuality.
Because libido is influenced by androgens, the male hormones that continue to be produced, women can continue to have strong sexual interests after menopause.
But the physiological changes resulting from the loss of estrogens, especially thinning of the walls of the vagina and lack of adequate lubrication, can turn once-pleasurable sexual encounters into painful experiences that women would rather avoid.
The resulting disruption of a couple's sex life can cause serious tensions in the relationship and is believed to be an important factor in many midlife divorces.
Even though the problem can usually be avoided or corrected, many women accept their fate as an inevitable consequence of age or are too embarrassed to discuss the matter with their physicians.
Others who do seek medical guidance may be advised against hormonal therapy because they have a personal or family history of cancers linked to estrogen.
For one woman in her mid-50s who is still sexually attracted to her husband of 26 years, the pain and bleeding associated with postmenopausal intercourse has brought their sex life to a regrettable end.
Yet, because the woman's mother and grandmother had breast cancer, her physician advised against estrogen replacement therapy and offered no alternative to help her remain sexually active.
A 62-year-old woman married 40 years wanted to know what to do to relieve the sex-related pain that began after her doctor advised her to stop using estrogens.
Another woman, 47, who had been enjoying frequent sex with her husband of four years, was bothered at first by declining lubrication during sexual arousal, which soon progressed into excruciating pain during intercourse.
Because she had not entered menopause, her doctor referred her to a psychiatrist. The physician did not realize that problems like hers could be related to hormonal declines that can start years before a woman stops menstruating.
And many physicians are unaware that there are both hormonal and non-hormonal ways to counter the problem, including a newly marketed gel that can decrease irritation and pain by providing continuous vaginal moisture.
Dr. Philip M. Sarrel, an obstetrician and sex counselor at Yale University's School of Medicine, recently summarized the effects of estrogen decline on sexual function. Writing in a supplement to the April issue of the journal Obstetrics and Gynecology, he cited these factors:
Cell growth and multiplication decline, since estrogen acts on cells as a growth stimulant. Loss of cells in the vaginal lining leads to thinning of the tissue and increased susceptibility to irritation and tears during intercourse.
Touch perception declines, which may make a woman less sensitive to tactile sensations that are an important part of sexual stimulation.
Blood flow to the genitals, and possibly also to the heart and brain, declines, which may decrease engorgement of vaginal and other tissues associated with sexual stimulation. Estrogens increase arterial blood flow.
In their classic study of human sexual response, Dr. William Masters and Virginia Johnson of St. Louis listed many physiological changes of menopause that can affect sexual functioning.
They include a delayed reaction of the clitoris to stimulation, delayed or absent vaginal lubrication, lessened expansion of the vagina during intercourse, and fewer and sometimes painful uterine contractions during orgasm. All these changes reflect alterations in sensory stimulation and blood flow.
Another common problem involves the woman's sex partner, who may develop sexual difficulties as a result of age, disease, lack of interest or in reaction to the woman's problem.
by CNB