According to the US Census Bureau, over the next two decades approximately 40 million women will reach menopause. Their average life expectancy will be 82 years. In addition, The National Vital Statistics found that 85 to 94 years old is now the fastest-growing age group in America. Does sex matter to women in this age group? A study conducted by AARP found that two thirds of women 45 to 59 years of age, 48% of those 60 to 74 years of age, and 44% of those 75 years of age or older believe that a “satisfying sexual relationship” is important to their quality of life. Another study conducted by the National Council on Aging found that 70% of menopausal women believe that sex is as at least as satisfying as when they were in their 40s (http://www.siecus.org/pubs/fact/fact0018.html).
To some of us, this information might come as a surprise. In my own training as an intern, it initially seemed that sex and sexuality were important topics only for young patients. I treated hundreds of patients for sexually transmitted diseases and delivered many dozens of young teenagers who learned about sex before they learned about contraception. Discussions about sex, sexuality, sexual abuse, contraception, and related topics seemed clearly an issue for the young.
It took another year for me to realize that menopausal women also view sexuality as very important. One of my first oncology patients was a lovely octogenarian being followed for cancer of the cervix. During the exam I found a metal clip on her cervix that was used as a radiology marker. When I asked her if the clip was painful for her partner, she matter-of-factly told me that her partner had left her after her diagnosis because he feared he would “catch cancer” from her during intercourse. Ironically, she might have contracted human papillomavirus from her partner, causing her to develop cervical cancer. I then asked if she ever masturbated. She looked at me and said shyly, “You know, doctor, I would never give up my afternoon bath.”
I'm a red hot mama from my head to my feet, Flashin' and a sweatin', drenchin' the sheets. Come a little closer, psst, feel my heat.
Yes I'm a red hot mama, I like to exercise, Tightenin' up my tummy, tonin' my thighs. Men still lookin' at me, and I look at guys.
My heart is palpitatin' and my face is turning red. I toss and turn all night but sexy thoughts still fill my head. I'm through with makin' babies, now I'm makin' love instead. Just because I'm in the “pause” doesn't mean I'm dead.
‘Cause I'm a red hot mama, I might take estrogen, calcium and soy, black cohosh, and estrogen. I may be getting’ older, but I'm wiser now than then.
Red hot, red hot mama, I'm a red hot, red hot mama.
1)If I didn't ask about sexuality, the patient would likely not talk about it,
2)There is a lot of misinformation about sexuality that needs to be addressed, and
3)If I thought sex ended with menopause, I was mistaken. Sex matters to menopausal women even if they don't have a partner.
In the menopause program that I direct, questions related to sexuality are among those most frequently asked. To help initiate a discussion of sexual function, I typically ask patients if they have any sexual concerns they would like to discuss, or if they are satisfied with their current level of sexual desire. Though some menopausal women will openly talk about their sexual concerns from the beginning of their visit, many will not mention it until the subject is brought up. Talking about it gives them “permission” to discuss these matters.
I also ask if they have vaginal dryness and if that makes intercourse uncomfortable. With all the concerns surrounding hormone therapy, problems with vaginal dryness have become even more common, and information about non-hormonal lubricants such as K-Y Jelly or vaginal moisturizers such as Replens becomes more important. Although testosterone is certainly an important factor in female sexual dysfunction, one report found that decreasing sexual function correlated more with decreasing estradiol levels than with decreasing androgen levels. (Dennerstein L, Alexander JL, Katz K. The menopause and sexual functioning: a review of the population – based studies. Annu Rev Sex Resb 2003;14:64-82). Other common factors that negatively affect menopausal sexual function include urinary incontinence, a lack of exercise, insufficient sleep, and chronic stress.
The quality of the relationship also has a major influence on sexual satisfaction with intercourse. In particular, intimacy is correlated with the mutual respect of her partner. Each of these topics requires time and a willingness to ask about the topic. If we do take the time to ask our menopausal patients questions that go beyond hot flashes, we will be able to help even more of them go from red hot to red hot mamas.
For more on this topic, see “Sex and menopause: The Sizzle and The Fizzle” on page 72 of this issue.
aDepartment of Obstetrics & Gynecology, University of Massachusetts Medical School, Memorial Campus, 119 Belmont Street, 4th Floor, Worcester, MA 01605, (617) 916-1880 office, (617) 964-4549 fax
Department of Obstetrics & Gynecology, University of Massachusetts Medical School, Memorial Campus, 119 Belmont Street, 4th Floor, Worcester, MA 01605, (617) 916-1880 office, (617) 964-4549 fax
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