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Your Sexuality at Midlife

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How's your sex life? If you answered "great," then congratulations are in order. Keep doing what you're doing. But if you answered "not so great," then this article is for you.

Although women talk about it a great deal, there's no real evidence that women's sexual desire decreases in the years just before and after menopause. In fact, one of the largest surveys of women and their sexual desire found very similar rates of low sexual desire among premenopausal and postmenopausal women (24 and 29 percent, respectively).

Having said that, however, it is important to acknowledge the effects changing hormone levels can have on a woman's sexual desire and pleasure. For instance, as estrogen levels drop before and after menopause, you may find intercourse more painful. That's because estrogen is important to maintaining the flexibility and moistness of the vagina. So if you've been avoiding sex because it hurts, talk to your health care professional as soon as possible. There are a variety of options, including local hormone therapies like creams and tablets that only affect estrogen levels in the vaginal area, over-the-counter lubricants, and even exercises that can help improve vaginal health.

Another hormone important to your sexuality is testosterone, an androgen hormone. Its levels begin slowly dropping in your twenties, so by the time you reach menopause, your ovaries and adrenal glands are producing about half as much testosterone as when you were younger. Although there is no reliable test to evaluate testosterone levels in women, it's an issue worth discussing with your health care provider.

While there are no FDA-approved medications to treat low sexual desire in women, many health care professionals prescribe low levels of testosterone therapy "off-label" for patients. If your symptoms improve, it may mean your levels were too low. Additionally, Estratest, a combination estrogen/methyltestosterone hormone therapy may be used to treat vasomotor symptoms (hot flashes and night sweats) for women for whom using estrogen alone is not effective or not appropriate.

Finally, the most important component to a satisfying sex life is not hormonal but emotional. Are you happy in your relationship? Does your partner know how to please you sexually? Are you experiencing significant stresses in your life that make sex the last thing on your mind? Midlife is a time of change. Career changes. Relationship changes. Family changes. Sometimes it might feel as if you're on an emotional roller coaster. And, as you've probably learned by now, a roller coaster is no place for a good sex life.

Regardless of why your sexual desire is lacking, it's important that you talk to your health care provider both to rule out medical conditions that can affect desire and to discuss options. When you make your appointment, tell the scheduler what it's about and ask if your provider or someone else in the office is comfortable talking about these issues. If not, or if you're uncomfortable bringing up sex with your health care provider, consider finding a new one or seeing a professional specially trained in women's sexual issues. Hopefully, you'll soon be answering the question at the beginning of this article with a big grin and a thumbs-up.