Women’s Sexual Health … Let’s Talk
by Dr. Janette Gray
As we honor women’s sexual health week, May 10-16, we have to celebrate recent wins like the approval for the first FDA drug that treats menopausal women for hypoactive sexual desire disorder (HSDD). It’s been more than 25 years since Viagra hit the streets and there are over 30 FDA-approved testosterone medications for men and none for women. Women’s sexual health has been gravely ignored and often dismissed or misdiagnosed. Perimenopausal and menopausal women are commonly told their symptoms are a part of aging and that eventually, they will get used to them. It’s not uncommon for a woman to be misdiagnosed with depression rather than hormone deficiency.
The topic of sex is often accompanied by shame or guilt. Society is afraid to talk about sex, so women usually don’t feel comfortable bringing up the topic with either their partner or health care provider. Additionally, we hardly have sex education in this country and most people don’t know the proper names for the female genitalia. How can a woman talk about symptoms of menopause or lack of sexual desire and arousal if she doesn’t understand and can’t even name her own body parts?
Yearly, millions of women going through the hormonal transition called perimenopause and menopause experience profound changes to their sexual health, from painful intercourse to loss of desire and arousal. In fact, up to 80% of women over 65 years of age have sexual health concerns. Sexual health issues can range from physiological changes seen with the genitourinary syndrome of menopause (GSM) to psychological symptoms. GSM can include pain with intercourse due to thinning of the vaginal tissues, recurrent urinary tract infections and urinary incontinence. These signs and symptoms can greatly interfere with desire and enjoyment from sex but are often not brought up by either the doctor or the patient. Treatment with vaginal estrogen is the best form of care and is very effective. It is estimated that the use of vaginal estrogen can decrease the incidence of recurrent UTI by 60% resulting in lives saved from sepsis and billions of health care dollars saved per year.
The psychological contributors to loss of desire are very common and complex but can be rooted in physical symptoms that act as a deterrent to desire or psychological reasons in the brain. First, the physiological changes that occur in the female vulva, such as thinning of vaginal tissues, decreased blood flow, decreased vaginal lubrication and loss of sensitivity of the clitoris, all contribute to loss of sexual desire and arousal. A decline of estrogen and testosterone in particular results in a decrease of serotonin and dopamine function in the areas of the brain, like the amygdala and hippocampus, where sexual arousal is believed to arise. Other symptoms of perimenopause and menopause include hot flashes, night sweats, moodiness and insomnia. Adequate quality sleep, being critical to mental health, energy and sexual wellbeing, is often affected by hormonal imbalance.
As is evident, many different symptoms can interfere with a woman’s sexual health. It is totally understandable why a woman who may be suffering from insomnia, feels irritable and is afraid of experiencing pain with intercourse would not be interested in sex with her partner.
The good news is that hormone imbalance and deficiency seen in perimenopause and menopause are easily treated with hormone replacement therapy (HRT) in most women. Estrogen, progesterone and testosterone are the three main sex hormones used to alleviate most of the signs and symptoms. Estrogen binds to over 300 receptor sites throughout the body, including the brain, bones, muscles and the female genitalia. Estrogen is commonly used to help with hot flashes and night sweats, preserve bone density, decrease the incidence of heart disease and Alzheimer’s and plump up the genital urinary system. Progesterone is a stabilizing hormone that balances estrogen, helps with sleep and reduces anxiety and stress. Testosterone is thought to be a male-only hormone; however, it plays a very significant role in women’s sexual health. As previously mentioned, it binds receptor sites in the brain to increase sexual desire in many areas of the body. It stimulates bones and lean body mass, which is critical to avoid osteoporosis and sarcopenia (muscle loss associated with aging). Testosterone also helps increase blood flow and sensitivity to the genitalia, which helps with arousal and orgasms.
Sexual health is a complex mix of bio-psycho-social factors that all play a role in a healthy and satisfying sex life. Longevity, which is living a longer, healthier life, is associated with many factors, including happiness, which stems from meaningful and close social interactions. In fact, studies show that people who live in isolation or lack significant socialization have a shorter life expectancy. Intimacy, which often involves a sexual connection, but not necessarily, plays an important role in our sense of well-being. The deep connection felt with a partner is often due to the closeness that occurs during sex. Therefore, women’s sexual health can play an important role in the overall happiness and quality of life.
Dr. Janette Gray is an internal medicine physician, hormone expert, author of The Truth about Sex Hormones, and medical director and founder of Perfect Balance Health, where she helps adults of all genders achieve optimal wellness through personalized Hormone Replacement Therapy (HRT) and comprehensive weight management programs.
