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Love after the menopause

A study identifies factors that compromise female sexuality after the reproductive age

PAULINE BONAPARTE BORGHESE, ANTONIO CANOVA, 1808After the menopause, when monthly ovulation stops and the level of female hormones drops a lot, the quality of the sex life of more than one third of all women deteriorates. They start avoiding sexual relations, largely because they feel discomfort and pain which makes sex almost a painful ordeal. These findings come from a survey coordinated by gynecologist, Aarão Mendes Pinto-Neto, from the School of Medical Sciences of the State University of Campinas (Unicamp) and detailed in three articles published in 2008 by the journal, Menopause.

In the work, part of the PhD thesis of gynecologist, Ana Lúcia Valadares, the researchers assessed the quality of the sex life of 378 women between 40 and 65, who were high school graduates, a very little studied population in Brazil. All those interviewed lived in Belo Horizonte, the state capital of Minas Gerais. They replied to a questionnaire that was developed in Australia and translated into Portuguese by the group from Unicamp. This questionnaire investigates sex life using questions dealing with the frequency of sexual relations (alone, or in pairs, with or without vaginal penetration), the intensity of the sexual pleasure felt and the frequency and intensity with which sex and sexual desire were thought about.

One of the results that drew the researchers’ attention was how frequently there was pain during penetration (a condition doctors call dyspareunia), a fact mentioned by almost 40% of those interviewed. “Between two and three years after the menopause almost all women feel some level of discomfort due to vaginal dryness”, says Aarão. In many cases this is nothing that information and a little lubricating gel cannot resolve.

The company of a loving and healthy partner was also shown to be indispensable for good sexuality. Ana saw that women whose partners had problems, like erectile dysfunction or premature ejaculation, had a greater tendency to feel pain during sex. One probable explanation, according to the researchers, is that in order to achieve a comfortable level of lubrication these women need more caressing, which a partner who is in a hurry may not always supply.

Dyspareunia was most common among women with depression and those who feel nervous about sex. As the questionnaire establishes the correlation, but does not indicate whether the pain causes the emotional problem or if it is the consequence of it, the researchers use their clinical experience to understand the results better. Based on the cases he has seen over more than 20 years study, the gynecologist from Unicamp believes that the physical discomfort comes before the emotional problem, and when women begin to anticipate the pain they will feel they begin to avoid sexual activity.

Some of the disagreeable signs of the menopause upset sex, which becomes the commonest sexual dysfunction among women who have these symptoms. This is no surprise. Anyone who sweats and has a sensation of a lack of air during hot flushes, who produces no vaginal lubrication, who suffers from insomnia, is depressed and goes through periods in which mood swings seem like a roller-coaster ride, to the point where she misses the pre-menstrual tension of her youth, is unlikely to look kindly on sex. Furthermore, drugs for depression and hypertension, common problems in this phase of life, can reduce sexual desire.

Personal measure
A good sex life, Aarão emphasizes, is that which satisfies the person involved. There are those who are happy to have sex once a month and those who think three times a week is little. He adds that sexual desire naturally reduces with age – not with the menopause. “A 50-year old man has less desire than he had when he was 20; the same happens with women.” It is for this reason that the researcher does not talk about good or normal sexuality, but a sexuality that is suitable for each woman.

Satisfaction, however, does not depend only on physical health. For a full sex life, the emotional health of the relationship must be fully satisfying. “To have suitable sexuality the woman needs to feel attraction for the partner”, says the researcher from Unicamp. The questionnaire included questions on how satisfied the participant was with her partner as a lover, if she was in love with him and generally speaking how she felt about him – or her, in the case of lesbian relationships. A larger proportion (from 71% to 86%) of the women who gave a maximum mark on a scale from 0 to 6 for each of these items – in other words, they were in  love, their partners satisfied them and they considered them as good companions – said they had a good sex life. Among the less satisfied with their partners, the sexuality of more than half (between 53% and 56%) was compromised.

Among these women from the Minas Gerais state capital it was clear that having a healthy sexual partner is important for a good sex life, but living with this partner confuses the situation. According to the gynecologist some sexologists argue that the cure for female sexual dysfunction is a young attractive partner.

Based on the results of this survey gynecologists can help women rescue their sexuality after their reproductive life has ended. To do so each individual patient’s case needs to be assessed and the most suitable solutions found for them. Hormone replacement therapy, for example, may reduce the lack of lubrication and hot flushes and certain sexual positions may be more comfortable and pleasurable for the woman. “Our function”, sums up Aarão, “is to offer women general well-being and preserve their health for their old age”.

The project
Sexuality in menopausal women: a population enquiry in Belo Horizonte (nº 04/10524-8); Modality: Regular Research Awards; Coordinator:
Aarão Pinto-Neto/FCM-Unicamp; Investment: R$ 32,391.30

Scientific articles
VALADARES, A.L. et al. Sexuality in Brazilian women aged 40 to 65 years with 11 years or more of formal education: associated factors. Menopause. v. 15, n. 2, p. 264-269. March-April 2008.
VALADARES, A.L. et al. The sexuality of middle-aged women with a sexual partner: a population-based study. Menopause. v. 15, n. 2, p. 706-713. July-Aug. 2008.
VALADARES, A.L. et al. A population-based study of dyspareunia in a cohort of middle-aged Brazilian women. Menopause. v. 15, n. 6, p. 1.184-1.190. Nov-Dec. 2008.