If you are a woman over the age of 40 and are experiencing a serious decline in libido and sexual function, you are not alone.
In my Naturopathic practice at NutriChem, 9 out of 10 of my perimenopausal and menopausal patients will have a complaint related to changes in libido and sexual function such as painful intercourse, difficulty with lubrication, reduced arousal and ability to orgasm. We hear you; we are listening, and we are here to help. Keep reading for a deep dive into a Naturopathic, holistic approach to treating and supporting sexual function.
In this part of our pleasure principles series, we will focus on understanding the changes in sexual function that occur in perimenopause. Let’s start with the basics of your genitourinary system. The genitourinary system includes the organs of the reproductive and urinary system such as the bladder, urethra, vagina and vulva. It is a complicated, intricate and delicate system that requires a healthy balance of hormones, bacteria and pH. During perimenopause and menopause, there are hormonal shifts and changes that occur that can impact the genitourinary tract, and subsequently, sexual function.
Here are the most common issues with sexual function in perimenopause and menopause:
1. Sex is painful and/or uncomfortable
During perimenopause and menopause, women can experience thinning of the vaginal tissue, shortened vaginal canal and reduction of elasticity of vaginal canal reducing the ability to stretch. These physiological changes that occur in perimenopause can result in painful intercourse or general discomfort with sexual activity. These changes occur due to lower levels of circulating estrogen. In addition, women in perimenopause may have other health conditions such as pelvic floor dysfunctions, fibroids or ovarian cysts which can contribute pain during intercourse.
2. Increased difficulty reaching orgasm or absent orgasm
Difficulty achieving orgasm in perimenopause can be due to numerous factors including lack of blood flow to tissue and lower circulating estrogen and testosterone. Testosterone levels start to decline in your 40s, and blood levels are approximately half of what they were in your 20s. This can contribute to lower levels of sexual desire and arousal. Testosterone can have a direct effect on the vaginal tissue and ability to reach orgasm.
3. Difficulty with lubrication due to vaginal dryness
Lower circulating estrogen levels contribute to increased vaginal dryness. Estrogen receptors in the vaginal canal help keep the tissues healthy and moisturized. It is common for women in perimenopause to experience vaginal dryness and difficulty with lubrication during intercourse due to lower estrogen levels. Luckily, this is treatable with local vaginal estrogen therapy or vaginal moisturizers.
Here are 5 ways to improve sexual function & pleasure in perimenopause
1. Use a vaginal moisturizer
Using a hormonal or non-hormonal vaginal moisturizer can help restore and replenish vaginal tissues, improving arousal, lubrication and sexual comfort in perimenopausal women.
Low dose vaginal estrogen moisturizers are a safe and effective treatment for painful intercourse and will help to improve blood flow and arousal. In addition to improvements in sexual function, it can help balance vaginal pH, prevent urinary tract infections and improve bladder function.
In a large observational study, there was no increased risk of breast cancer, endometrial cancer or cardiovascular disease with the use of vaginal estrogen therapy.
In addition to vagina estrogen therapies, a vaginal suppository containing DHEA (dehydroepiandrosterone) called Prastone is an effective treatment for painful intercourse in menopausal women. It has been approved for use in Canada for this indication. Talk to your healthcare provider to learn more about vaginal DHEA.
Although not as effective as vaginal estrogen therapy, for those who have contraindications to estrogen therapy there are non-hormonal moisturizer options available. Common brands include Gynatrof, Repagyne or IRIS, these moisturizers contain hyaluronic acid and vitamin E which can help to support the health of vaginal tissue.
2. Use your menstrual cycle to plan for peak arousal:
Using your menstrual cycle to predict natural hormonal shifts may help to support optimal sexual desire and function. Prior to and during ovulation, estrogen levels are at their peak, which can help contribute to increased arousal, lubrication and ability to orgasm. Pretty much right after your period ends, start thinking about sexual activity. Heightened premenstrual symptoms (PMS) such as bloating, bowel changes, discomfort, irritability, and breast tenderness are common in perimenopause, which can lead to less desire towards sexual activity.
3. Start using a lubricant, and a good one:
First off, there is no shame in the lubrication game. Lubricants can help to support arousal, reduce pain with sexual activity, and help women achieve orgasm. Choosing the right lubricant for sexual activity is critical. In perimenopause, the vaginal tissue is already very sensitive and susceptible to pH changes. Your typical drugstore lubricant can actually worsen vaginal dryness and disrupt pH balance. I typically recommend a water based lubricant that is pH balanced (i.e. YESVM). Please note, a lubricant is not the same as a vaginal moisturizer. A lubricant is solely used for purposes surrounding sexual activity.
4. Consider regular self-stimulation:
Regular self-stimulation and activity involving the vulva and vagina can help promote blood flow to the genital area and natural secretions which can help maintain optimal vaginal health. The use of a vibrator can help to maintain vaginal width, length and tone. For female orgasmic disorder, the use of a vibrator or other self directed masturbation can help a woman become more aware and comfortable in her body and assist in supporting blood flow to the tissues.
5. Get to know your pelvic floor:
Pelvic floor dysfunction can impact sexual function through overactive (high-tone) or underactive (low-tone) muscles of the pelvic floor. This can result in difficulty with arousal, orgasm, maintaining contraction, relaxing, pelvic pain and/or pain with intercourse. Addressing these concerns with a qualified pelvic floor physiotherapist can have a huge impact on sexual function. Pelvic floor physiotherapists can also assist with the use of a vaginal dilator, which is a small device inserted into the vagina to help improve elasticity and reduce pain with sexual activity.
In conclusion, while perimenopause can bring about significant changes in sexual function, there are many effective strategies to regain comfort and pleasure. By understanding the hormonal shifts that affect your body and incorporating practices like vaginal moisturizers, lubricants, and pelvic floor exercises, you can support your sexual health during this transition. Remember, you’re not alone in this journey—consulting with a naturopathic doctor and exploring personalized treatments can make a world of difference. Embrace this time as an opportunity to prioritize your well-being and rediscover pleasure in your own terms.
References
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Hoeppner, C. G., Cigna, S. T., Perkins, J., & Gaba, N. D. (2021). Sexual health. Clinics in Geriatric Medicine, 37(4), 553-577.
Labrie, F., Archer, D. F., Koltun, W., Vachon, A., Young, D., Frenette, L., … & Moyneur, É. (2018). Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause, 25(11), 1339-1353.
Shifren, J. L., Gass, M. L., & NAMS Recommendations for Clinical Care of Midlife Women Working Group. (2014). The North American Menopause Society recommendations for clinical care of midlife women. Menopause, 21(10), 1038-1062.
Thornton, K., Chervenak, J., & Neal-Perry, G. (2015). Menopause and sexuality. Endocrinology and Metabolism Clinics, 44(3), 649-661.
