Sexual Health at Menopause

This post was written by H&W instructor Michelle Lyons, PT, MISCP, who authored and instructs the course, Menopause: A Rehabilitation Approach. She will be presenting this course this February in Florida!

Menopause is often euphemistically referred to as ‘The Change’. Historically it was treated with everything from hysterectomy to hormones, and even hospitalization (often in psychiatric institutions). Dr Christiane Northrup writes “Perimenopause is a normal process, not a disease.” But she also writes “It’s no secret that women experience a decrease in their sex drive during perimenopause.”

But according to a study presented by Gavrilov in 2007, American women aged fifty five and older enjoy sex more than women a decade ago who were the same age. Today’s menopausal women, they report, consider a healthy sex life to be part of a healthy lifestyle.

Although it has been reported that genital sexual responsiveness of premenopausal and post menopausal women doesn’t differ significantly (Van Lunsen 2004), many women report painful intercourse possibly because of vaginal dryness or vulvar-vaginal atrophy caused by decreased levels of estrogen. Symptoms of vulvar and vaginal atrophy (VVA), including dyspareunia and vaginal dryness, have a distinct negative impact on a woman's quality of life. The REVIVE survey (Freedman 2014) highlighted the lack of awareness of VVA symptoms among postmenopausal women with vaginal symptoms, with many women reluctant to initiate discussions with their healthcare professionals despite the presence of vaginal symptoms.

The vast majority of postmenopausal women will develop VVA at some point in their lives (Freedman 2008) and up to 50% will experience physical symptoms of vaginal atrophy, particularly dyspareunia (pain with intercourse), vaginal dryness, and vaginal irritation (Santoro 2009). Furthermore, the prevalence of VVA in postmenopausal women is likely to increase, secondary to factors such as the aging population, increased longevity, and a decline in the use of systemic hormone therapy (Gass et al 2011) Despite the increased prevalence of VVA, many women report that their healthcare professional (HCP) did not inquire about specific conditions such as dyspareunia during routine examinations.

Sexual function is a complex, integrated phenomenon that reflects the health and balance not only of the ovaries and hormones but also of the cardiovascular system, the brain, the spinal cord and the peripheral nerves. In addition, every factor that affects sexual function has underlying psychological, sociocultural, interpersonal and biological influences of its own. (Northrup 2012). And then of course there is pelvic health! Pelvic therapists are in a unique position when it comes to dealing with sexual health – we may be the only health care professional capable of integrating interviewing about sexual health with an external and internal pelvic floor muscle exam, as well as our advanced skills in merging and interpreting the relationship between the spine, hips, pelvic girdle and the pelvic floor. We can combine our skills in assessing and addressing any pelvic floor muscle dysfunctions along with advising about sexual ergonomics secondary to orthopedic issues in the lumbo-pelvic-hip complex.

Interested in learning more about Menopausal health? Join me in Orlando in February for my new course ‘Menopause: A Rehabilitation Approach’