MANY years ago it was accepted that as women age and their hormones change, they lose interest in sex. You wouldn’t think menopausal women as being sexually active. Today, we know this doesn’t need to be the norm. There is no reason why women in their 60s and 70s can’t be as sexually active as they were previously.
Obstetrician and gynaecologist Dr Kim Wong explains that libido increases from puberty up till the time women are in their 20s, 30s and 40s. When they are close to perimenopause and menopause, their libido will decline.
“This decline in libido is because of the hormones, because the ovaries are not producing a certain amount of testosterone and oestrogen. These are the two hormones that are very important for women’s libido,” says Dr Wong.
Apart from the low testosterone and oestrogen, women also lose interest in sex because as they grow older, they usually have medical problems like fibroids or cysts and they might have to go for surgery like hysterectomy or to remove their ovaries. That itself will cause a reduction in libido.
They also grow tired more easily as they age.
In addition, those on medication for things like epilepsy and psychiatric problems can also have reduced libido as the medication will interfere with their hormone production.
Dr Wong explains it simply: “When the testosterone is low, the urge to have sex is reduced and if the oestrogen is low, the organ involved in sexual intercourse is not comfortable or normal. It’s dry and the skin is thin, so having sex becomes painful and the lubrication is less. The fear of pain will take them one step back when it comes to sex.”
All hope is not lost as there are several options to overcome low libido.
If the cause is menopause, then the treatment would be to replace the hormones through oestrogen replacement therapy.
“We can even give them medication which has a testosterone stimulant effect. For example, there is a synthetic steroid which has an androgenic effect which increases the libido in women. We can also give them some medication that encourages the vagina to be healthy. For example, oestrogen cream or an oestrogen gel that encourages the vagina cells to grow and multiply and produce enough lubrication for sexual intercourse. When there is lubrication, sex becomes enjoyable and they will have libido again.
“The lubrication makes women feel comfortable while having sex. It makes the sexual encounter enjoyable. If you don’t enjoy it, you will shy away from it. That is what happens when there is reduced libido,” explains Dr Wong.
According to her, there are a few types of oestrogen that you can apply to the vagina. There is the E2 which is estradiol. This oestrogen goes into the bloodstream and, from there, the chemicals travel elsewhere. The other parts of the body that are stimulated by this oestrogen are the breasts as well as the womb. The stimulation from the oestrogen will cause the endometrium, or womb lining, to grow.
She cautions that there are risks with E2 usage. If the proliferation of the cells in the womb lining is not carefully controlled and the cells continue to grow, it can lead to abnormal cells, hyperplasia cells and even endometrial cancer.
The other oestrogen is E3 or estriol. This one is thought to be safer because it only has a stimulant effect in the vagina, perineum, vulva and, to a certain extent, the cervix. It doesn’t have any stimulant effect in the womb.
According to Dr Wong, E3 is very good for the vagina’s health and has no stimulant effect on the uterus. That’s why it doesn’t cause womb cancer. It also doesn’t travel into the bloodstream to affect the breast, therefore it doesn’t cause breast cancer.
While estriol is available in tablet form, not many women are aware of it.
Food of love
For those who don’t want any hormone treatments, there is always a more natural route.
The good news is aphrodisiacs are not a myth. Some foods can be beneficial in increasing a woman’s libido.
Among them are strawberries, avocados, black raspberries, broccoli, clover, figs, ginseng, ginger, oysters, and garlic.
Dr Wong informs that herbal supplements like zinc as well as vitamin E and C, and phytoestrogens found in plants can help as well.
She also encourages women to exercise as it increases blood flow to all parts of the body, even the vagina, ovaries and reproductive organs.
Dr Wong believes that increasing the libido involves the physical as well as psychological aspects. Both require the woman to be happy and not in pain or stressed.
She says that feeling down or anxious and stressed will not help.
The woman should feel good about themselves and less anxious and tense. If you feel frightened of your partner and are only having sex because your partner wants it, the joy is not there. It’s as if you are having sex because of fear and that is a negative feeling.
The partner also should understand this and should help the woman to overcome these negative feelings by making them relaxed and comfortable.
“Sometimes the environment is also very important. Take a holiday, go to a new environment, a comfortable and cosy environment, with music and visuals. Perhaps a holiday by the beach … not one of those hectic holidays.
“The partner is very important. If the problem is that the wife is menopausing, then it’s good for the partner to sit directly in front of her and talk to her. Eye contact is very important. It gives the woman assurance, confidence and hope. He should talk to her face to face rather than from the side or the back. It’s very important for them to talk and express what they want. If they are facing a libido problem, it is good for them to sit down and talk about it.
“If libido is low, you would also need to depend more on foreplay and it’s very important to bring out the emotions through kind gestures. They should spend more time on foreplay and enjoy themselves,” says Dr Wong.
She suggests couples not have rigid protocols like insisting everything must be clean or having their bath first. Being spontaneous and having impromptu sex can also be exciting and help increase the woman’s libido.
If they feel that low libido is causing them stress, affecting their quality of life and causing a strained relationship, then Dr Wong recommends seeing a gynaecologist.
Seniors should have sex
Dr Wong says seniors can and should have sex as it helps lift their mood and makes them more confident and boosts their self worth. Sex releases the chemicals serotonin and endorphins. As such, women who have sex will be happier and find they are better wives, mothers, and workers.
The prostaglandin compound in the men’s semen also assists the woman in feeling loved and happy when she comes into contact with it.
“Libido is a very important feeling that women should have. We shouldn’t suppress it or think that it’s a bad thing for women to have. In women who are menopausal, all the more they shouldn’t suppress it, because menopause is a bag of problems that women have to face. The last thing they need is to feel worthless or that their partner doesn’t want them anymore. I think that’s the last thing they should have to deal with.
“They should feel the same way as they did before menopause. This is very important and sexual activities indirectly help women feel happier. So, I don’t think they should suppress it by thinking that they have gone through menopause and they no longer need to have sex. Women shouldn’t feel that menopause is the end of everything. Life should continue to be as good as it was before menopause.”