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Where Did My Libido Go?

November 26, 2019

Many of my patients, friends, colleagues and myself are among the 2 million women yearly who have entered menopause in the US since 2000. Besides dealing with the symptoms of menopause, what’s happening to our sex lives is a hot topic. I ask all of my patients at their annual gynecological exams, if they have concerns about their sexual health. Almost every woman in her 40s and beyond describes changes in their sex drive, sexual satisfaction, and often post-menopausal discomfort with intercourse. Some of the comments I’ve heard include, “Where did my libido go?”, “I’m so dry, I have Sahara vagina”, “I love my partner, but I’d rather have a glass of wine and read a good book than have sex”, “I get sore because it takes so long for me to reach orgasm and he’s having trouble going the distance too” “We’re not having sex as often and it’s affecting our relationship.”

What Happens to our Hormones?
As women move through peri-menopause, menopause and beyond, the reproductive hormones estrogen, progesterone, testosterone, DHEA, and oxytocin fluctuate and eventually (usually in our 50s), settle at much lower levels. This has systemic effects on all women’s bodies and is a natural transition, but may present a challenge to women’s physical, emotional, and sexual well-being.

Lower hormone levels cause multiple vulvovaginal and urinary tract changes. The mucus membranes of the vagina become thinner, are not as stretchy, and produce much less natural secretions. This can lead to dryness, irritation, pain with intercourse (dyspareunia), and increased risk for yeast or bacterial overgrowth. Also, there’s a decrease of the beneficial lactobacillus bacteria needed in the vagina to keep the vaginal ph at a healthy acidic of 3.6 to 4.5.

The bladder and urinary tract are also sensitive to hormone changes. Many women experience more urinary tract infections, urinary urgency, having to get up often at night to urinate, and incontinence or “leakage” as portrayed in advertisements for pads and “lace edged French cut” pull-ups.

Therapeutic Choices for Hormonal Decline
Thankfully, there are hormonal and other therapeutic choices for women to address these issues. MDs and Naturopathic Physicians can provide vaginal estrogen and DHEA, in the forms of creams and suppositories, which can help regenerate the vaginal mucus membrane, tissue pliability and restore natural secretions. Recent research in the Lancet and Menopause medical journals has shown vaginal estrogens do not appear to raise a women’s risk for breast cancer, uterine cancer, stroke, or deep vein clots. This is good news for women wanting to explore the benefits of this hormonal option.

A non-hormonal therapy involves using safe vaginal lubricants which can help moisturize the vagina, but only if they’re the right osmolality. Osmolality is a measure of the concentration of substances in a liquid. The osmolality of vaginal secretions is 260-360 osm/Kg. High osmolality lubricants inserted into the vagina pull fluids through and from the vaginal membrane tissue, increasing liquid in the vaginal vault but can dry and damage the tissue. High osmolality (osm/Kg) lubricants include: Replens 1491, Astroglide 4,500, KY personal lubricant 2,200, and KY Warming 8,600 (yikes!). I strongly recommend avoiding these products because they also make women and men more susceptible to sexually transmitted infections.

My favorite recommendation for vaginal moisturizing internally and topically (anywhere), is coconut oil. Its osmolality is at 180-340 osm/Kg and is ph compatible at 3.5-5.5, but because it’s oil it can’t be used with latex products such as condoms. It has a high flash point, for cooking that is. I suggest women keep a glass jar of it bedside. Cold coconut oil is solid and slipping a scoop of it up into the vagina makes it a great lubricant as it melts. If it’s warm it liquefies and can be applied liberally to both partners. Be certain that you and your partner isn’t allergic to it.

Two commercial low osmolality products that are less likely to cause vaginal irritation and may be used with condoms include: Good Clean Love Naked (194osm/Kg) and Sliquid Organics Natural (106osm/Kg). Good Clean Love Naked is available online and at most “Stop & Shop” in the condom section. Sliquid Organics Natural is also sold online.

Healthy Vagina and Urinary Tract
There are other ways women can ensure a healthy vulvovaginal and urinary tract environment. Women’s probiotics (taken by mouth) that include Lactobacillus reuteri and rhamnosus improve vaginal ph and help prevent infections. Using gentle body products such as Dove or Kiss my Face Olive Oil bar soaps, instead of any liquid washes and hypoallergenic detergents, lessen chemical irritation to the vulvovaginal tissue. Always rinse well after washing and partners should use the same gentle products.

Women having healthier vaginas and urinary tracts can revitalize their physical experience of sex, but many women are still affected and concerned about having less desire and sex drive. I’m not a therapist, but I’ve had the privilege of listening and learning from the patients in the past 28 years. There are older couples in my practice who are happy with their intimate lives. I’ve observed letting go of past sexual expectations and being communicative and respectful of shared physical changes are inherent to co-creating a new sexual intimacy.

There’s one last interesting study to mention. Brain scans during female orgasm showed women had to be comfortable and have their feet kept warm before they felt like having sex. I would suggest couples learn how to share foot massages or perhaps for women to have a pair of cozy, comfy “bed” socks on hand.

Every woman, man, established couple and new partners make this journey through mid-life and beyond in their own way. May yours bring you good health, the wisdom of maturity, and fulfilling relationships, whether or not that involves sexual intimacy is up to you.

Dr. Michelle J. Pouliot ND. New Hartford Naturopathic Health Center LLC. 860.238-7983. http://www.drpouliot.com.

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