SYMPTOMS AND SIGNS OF THE MENOPAUSE: SEXUAL SYMPTOMS

Complex biological, emotional and social factors influence sexual behaviour. Sexual difficulties are common during the peri-menopausal years and may include poor sexual response, discomfort during intercourse, reduced libido and loss of interest in the sexual partner.

The mechanism of the sexual response is complicated and involves not only the body's reaction to touch and erotic stimulation but also the mental and emotional awareness of the partner's feelings. Gentleness, tenderness and consideration on the part of the partner will be of immense benefit at this time.

Oestrogen, when plentiful, maintains the size, shape, skin thickness and flexibility of the vagina and profoundly influences response to touch through its effect on skin sensation, lubrication and blood supply. Insufficient oestrogen can cause changes that make sexual intercourse uncomfortable, painful or even impossible. An understanding partner will appreciate that the vaginal dryness (resulting from lowered oestrogen levels) associated with the menopause will take longer to overcome during foreplay (the best method of lubrication yet devised). But if the difficulties are more severe it is well worth discussing them with a doctor so that they can be dealt with at an early stage.

Oestrogen rejuvenates the vagina, making it thicker, more flexible and more moist, but by no means all women need oestrogen replacement to maintain good sexual function after the menopause. An active sex life in itself plays a major role in keeping the sexual organs in good condition.

Sexual problems may stem from longstanding dissatisfaction or disappointment that over the years sexual fulfilment has not been achieved; poor communication and lack of warmth and closeness in sexual relationships may be responsible. Erection problems in the partner may have occurred before the female menopause, producing resentment and sadness. Difficulties such as these are common in men over 50 years of age but can be effectively treated in some cases by counselling, or by penile prosthetic surgery or injections self-administered by the male partner to produce erection enhancement.

Impotence in the male is sometimes related to the female menopause. In this case it usually stems from fear of hurting the partner, and may be compounded by a lack of arousal in the woman. Poor penile erection, with consequent short erection time, may lead to a feeling of frustration on both sides and increasing loss of interest by the woman.

Sexual disorders may include painful intercourse (dyspareunia), lack of orgasm - often due to loss in quality of pleasurable genital sensation - and reduced arousal. Oestrogen therapy is of benefit here, and the application of a lubricant can ease discomfort and heighten tactile sensation.

It is true that sexual function may be reduced as the result of menopausal symptoms such as tiredness, irritability and depression. Conflicts arising from sexual difficulties tend to magnify sexual problems and further reduce sexual desire.

In Western society attitudes towards sex have changed greatly over the last few decades. The use of the oral contraceptive pill has been partly responsible, but greater freedom and openness in the discussion of sexual matters have been of equal importance. Today women should expect continuation of a healthy sex life far beyond the menopause. The understanding and communication of problems will help them to achieve, and sustain, a fulfilling sex life.

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Womens health