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SEX AND AGING: HORMONAL CHANGES

The hormonal changes that occur in menopause do create various physical side effects, however, which may affect female sexual response. Because estrogen is the hormone that fuels the development of female sexual organs, the long-term effects of lowered levels of this hormone include physical changes in the vagina. These changes include a gradual thinning of the vaginal walls and a subsequent loss of vaginal elasticity and cushioning. The result is a narrowing of the vaginal opening. Losing estrogen also results in a lessening of vaginal lubrication during sexual arousal. This combination of lessened vaginal lubrication and elasticity can result in discomfort during intercourse unless additional lubrication is used. Such lubricants include surgical jellies (like K-Y Jelly), Albolene Cream, and Lubrin.
Many women going through menopause are treated with estrogen replacement therapy to lessen the uncomfortable symptoms of this period of hormonal changing. A combination of estrogen and progestin is prescribed in order to mimic the body's former cycle of hormonal secretion, and symptoms such as hot flashes, irritability, and vaginal changes are thus diminished.
Estrogen replacement therapy was originally thought to increase the risks of breast and uterine cancer and to pose particular risks for women suffering from hypertension or heart illness. However, current medical thought seems to be that, when properly prescribed and taken, this is a relatively safe and effective therapy for virtually all menopausal women, including those suffering from heart illness. I strongly recommend that you consult your gynecologist about this option. Most menopausal women report significant improvements in overall quality of life and enhanced sexual enjoyment as a result of estrogen replacement therapy.
It is obviously true that aging does, indeed, affect sexual responsiveness. However, the good news is that we maintain our ability to respond sexually throughout our lives, particularly if we continue to exercise our sexual organs. Men and women in their sixties and seventies respond more fully to sexual stimulation if they maintain patterns of regular sexual response, either through lovemaking or through masturbation. In other words, the best way to keep from losing it is to keep using it.
Advancing age also typically brings increased maturity, wisdom, and relationship security. These factors should lead to increased flexibility in your attitudes toward sex. Expand your perspective from the narrow notion that sex has to do only with an erect penis inside a lubricated vagina. Think of your sexual relationship with the freeing notion that lovemaking has to do with orchestrating a whole symphony of intimacy containing many movements, variations on the themes of affection and communication, and intimate behaviors. With this expansion of attitude comes the stuff that makes a better sex life.
Even though your body changes in the direction of some slowing of the sexual response as you age, remember my prior comment: The body's largest sexual organ is the brain. Understanding the facts about sex and aging should help you develop and maintain a soothing attitude about this aspect of life.
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TAKING ESTROGEN

With the onset of menopause, many women suffer from hot flashes and night sweats. Arlene March, 56, a Los Angeles psychotherapist, says she started getting hot flashes 5 years ago. “I’d be working,” she recalls, “and suddenly feel intense heat all over my body. I’d break out in a sweat. I’d have to stop work. Then Dr. Mishell prescribed estrogen pills, and I’ve not had a day of discomfort.”
Some women experience a drying and thinning of vaginal tissues in the absence of estrogen, making sex painful. They also might suffer urinary tract infections and incontinence. Estrogen therapy often helps.
Among the physicians consulted, the most cautious was Dr. Morris Notelovitz, founder of the nation’s first Menopause Center, at the University of Florida, and head of the Women’s Medical and Diagnostic Center in Gainesville, Florida. He says each symptom needs a different treatment and advises that genital tract problems be given estrogen treatment for a couple of years at most. He also urges special measurements of the bones before prescribing estrogen therapy for osteoporosis.
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WOMEN’S HEALTH

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