SEX IN OLD AGE: THE MENOPAUSE
Posted by adminFor women, the sexual situation can be complicated by the menopause. This is another area in which physical and psychological factors interact. Some women welcome the menopause because it liberates them from the fear of pregnancy but its approach is viewed by many as the end of their sex life. Those who really believe that sex is only for babies often suffer badly, as do self-centred women who measure their personal worth by their sexual attractiveness.
Because the menopause often coincides with the departure of children from the home, a woman who has invested all her energies in loving and caring for her children loses her role at the same time as her sex life (in her view). As her husband, who on average is three or four years older than she is, may be becoming sexually uninterested or seeking new partners, additional stresses are added. If her husband is successful in his career, he may be even more involved in his work than in previous years and will be less available just when she needs him most. Understandably some women become anxious, critical and unhappy, which tends to alienate their partners and perhaps discourage them from sex.
Any social, personality and temperamental differences between the couple become more pronounced and some such couples divorce once their children have left home. Unless a woman takes steps to counteract it even her circle of women friends diminishes as they lose the common experience of rearing children. In such a state of mind her preoccupations are more likely to turn inwards and menopausal symptoms assume an importance greater than would otherwise have been the case.
A woman’s ovaries begin to ‘shut down’ from her mid- to late thirties. The supply of available eggs gradually becomes exhausted and their quality declines. The pituitary gland increases its secretion of sex hormones in an effort to stimulate the ovaries but, when egg production finally stops supplies of oestrogen and progesterone fall.
Some women report a loss of sex drive after the menopause. In some this can be explained by the modest fall, of around 25 per cent, in testosterone (the sex-drive hormone of both sexes) but in others depression, a deteriorating relationship with her partner, sex-avoidance by him, or the belief that her sex life should have ended, may also be involved. There may be pain on intercourse, resulting from vaginal dryness and thinning of its lining, and this too can put a woman off sex.
As the menopause approaches, some women experience an increase in sexual interest and pubescent fantasies of the rape and prostitution type may occur. Extra-marital intercourse is not at all uncommon at this stage if a woman sees it as her last chance. Many women say that they have less intercourse than they want at this period of their lives. Masturbation rates often peak as the inhibitions taught in early life recede but in general, as with men, women tend to continue the habits of earlier years. However, although the intensity of sexual arousal may decrease around the time of the menopause orgasmic capacity in intercourse certainly does not. In fact, some women first experience orgasms in intercourse at this time of life.
Around the time of the menopause and afterwards women may be more likely to suffer from heart attacks. This is probably due, in the main to the reduction in oestrogen levels which previously protected them. But there are certainly other factors too. In a survey comparing 100 women who had suffered a heart attack (and survived – those who died were obviously not available for questioning) between the ages of forty and sixty with a similar group of women who had not, it was revealed that 60 per cent of the heart-attack group had either not been able to have orgasms during intercourse or no longer had intercourse because of their husband’s incapacity, compared with only 24 per cent of the second group.
Similar evidence is available from studies of men suffering from heart attacks. Around
two-thirds have been found to have had significant sexual problems before the onset of the attack.
From this and other research it seems reasonable to conclude that to the established practices for the avoidance of heart attacks – such as not smoking – we should add, for both sexes, the establishment of a successful sex life. Some investigators have also concluded that a good sex life in later years wards off mental deterioration.
Some older people with arthritis, which is increasingly common with age, find that their condition improves after intercourse. There is now some evidence to suggest that people who continue to practice and enjoy sex tend to live longer, but it is not possible to claim that sex itself makes for a longer life because it is equally possible that whatever factors promote a full sex life also promote a longer life.
The average age for the menopause is now around fifty. Those who start menstruating late tend to finish early: around 4-per cent do so in their early forties. Women of fifty-two and
fifty-three have given birth to live babies – sometimes after a year or two without periods. Because of this, it is advisable to use some form of contraception for a year after the periods stop. The menopause lasts for between six months and three years.
Although all manner of symptoms are attributed to the menopause they fall into three groups, vasomotor leading to perspiration, hot flushes and night sweats; metabolic due to falling levels of oestrogen and resulting in thinning of the vaginal wall, a dry vagina and skin changes; and psychological including the loss of sex interest already mentioned, depression, lassitude, insomnia, loss of concentration, and irritability. Two more hidden consequences are the effects on the heart, mentioned above, and on the bones. Not all women experience a difficult menopause but it tends to be worse in smokers. For example, around a quarter of women are troubled by vasomotor symptoms.
The adverse effects on the vagina can be offset by oestrogen preparations used in the vagina and by using the vagina more in intercourse and/or masturbation. One small difficulty is that the partner can absorb oestrogen through the penis and in rare cases this can be sufficient to make his breasts enlarge. However, a side benefit of vaginal oestrogen is that the urinary problems which are common in older women are often relieved.
However, all the troubles can usually be controlled by hormone replacement therapy (HRT) which, as the name suggests, aims to make up for the reduction in production of female hormones. The topic is controversial but medical opinion is now turning towards the more extensive use of HRT. Tablets, usually, are taken by mouth and the oestrogen in them relieves the symptoms. However, there is a risk of cancer of the endometrium (lining of the womb) and to control this progesterone is added for 10 or more days each month. The progesterone also has a mild sedative effect and relaxes muscles. Women who cannot take oestrogen for one reason or another may be given progesterone only. Problems are that withdrawal bleeding usually occurs and appears to be like a normal period but does not indicate a return of fertility. Fluid retention and breast discomfort may also occur. Regular medical checks are necessary.
The psychological problems of the menopause are often alleviated as a result of increased self-esteem and happiness as the physical symptoms recede.
Most doctors believe that HRT, if used at all, should be restricted to the year or two after the menopause but some now believe the benefits to be so great that it should be continued to 65 or even older.
One benefit is the reduction in bone loss (osteoporosis) which occurs rapidly in the years immediately after the menopause. It afflicts a quarter of women between 55 and 65 and half of those between 65 and 75. The problem is to know which women will be affected. Women of short stature, with small bones, who had an early menopause, who are lean, or who have a family history of osteoporosis may be especially vulnerable.
Apart from causing the bend in the upper spine known as a dowager’s hump, osteoporosis leads to bones being fractured easily and this is serious. Hip fractures (45,000 a year in the UK) are the most serious. They are increasing in frequency and a fifth of women suffering them are dead within six months. Oestrogen stops or reverses bone loss. For Women not on HRT, increasing calcium intake, for example, by drinking more milk, does not help but those on HRT do benefit from extra calcium. Exercise is beneficial and post-menopausal women, whether on HRT or not, should make considerable efforts to keep fit and not fall into the trap of becoming inactive. Exposing the skin to sunlight also helps.
Women on HRT are a third less likely to die than women of their age not on HRT, but other factors may affect this statistic. Their chances of heart disease are reduced by two-thirds and of cancer of the endometrium by half. Cancers of the breast and ovaries may also be reduced. Women, after years of being on the Pill, might not want to face a fresh bout of pill taking at the menopause and at the moment their GP is unlikely to raise the topic. The benefits, though, are so great that more women than at present are likely to be asked to consider HRT in the future. Oestrogen has the added effect of maintaining pre-menopausal skin and body characteristics.
Although the topic is the subject of considerable debate and controversy, it is now widely agreed that men can also have a menopause. It is thought to affect around 15 per cent of men. A few even have not flushes. Psychological factors can also afflict men in their fifties and sixties as they realise they are not going to live for ever, that they have not fulfilled their earlier ambitions and dreams and that younger men can beat them in many ways. Obviously if both partners are suffering from bruised egos at this stage of their lives they can either mutually support each other or blame each other.
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