Question: How does menopause affect sexuality, and is there anything I can do to improve sex after menopause?
Answer: There has always been the belief that at menopause, women automatically lose their interest and their ability to be sexual beings. And the fact is that that's a myth. There are some factors related to menopause that can cause problems, but it doesn't necessarily mean that all women at menopause shut down sexually.
Now, the issues related to menopause that can cause a problem are two-fold. One is, at menopause women will lose estrogen levels. By definition the ovaries are no longer producing estrogen and therefore, with that, the genitals become a little, what we call atrophied. They start to actually narrow; the vagina narrows.
The tissue in the vagina becomes thinner, a little bit more irritated, and there's less lubrication. And obviously, that can result in discomfort and lack of sensation with regard to sexuality. So that would be one change that's related to menopause.
But similarly, a second change is related to testosterone levels. As testosterone levels decline, and believe it or not, women have testosterone just like men do, just not as much; testosterone is what we think of as related to sexual drive, that sort of biologic urge to be sexual.
And as testosterone declines because the ovaries are producing about 50 percent of testosterone in women, that too may cause a change in sexual interest and may cause what we call "low desire."
So, we need to pay attention to both the estrogen changes that occur at menopause and the testosterone changes that may occur at menopause -- particularly for women who have their ovaries removed by surgery, because actually, our testosterone levels are declining from our 20s on in women. And menopause may not be the trigger, but certainly removing ovaries can be a very noticeable change.
So, everybody should think about that when they're thinking about what changes am I having related to menopause.