Women often suffer sexual problems in silence

Painful sex. A lack of desire. An inability to lubricate. These are some of the most common sexual complaints facing women as they age, yet a majority of women are not getting the help they need from their doctors to solve those problems, according to a new study from the University Hospitals Cleveland Medical Center.

“Many post-menopausal women are certainly suffering in silence, and deserve to have a healthy, satisfying sexual life,” said lead author Sheryl Kingsberg, chief of the Division of Behavioral Medicine at University Hospitals Cleveland Medical Center. “They don’t want to sit back and watch their sex lives wither away.”

The study, being presented at the North American Menopause Society meeting this week, asked more than 500 women aged 40 to 75 years and older, who were currently in a partnered relationship, about the quality of their sexual lives and how that impacted their relationships.

“There is a myth in our culture that as women age they lose interest and motivation in wanting healthy sexual function and that’s just not the case,” said Kingsberg, who is also associate editor for the Journal of Sexual Medicine and sits on the editorial board of the journal Menopause. “Many of the women we surveyed said more sex would enhance their relationships, although it’s not the only thing that maintains a healthy relationship.”

In the survey, women in their 40s were most concerned with how sexual problems affected their enjoyment in a relationship; women in their 70s the least concerned.

“The level of distress tends to decrease the older women get,” Kingsberg said. “One reason is that women in their 40s are just coming face to face with these physical changes and are quite distressed with aging and the changes that creates in their sexual lives.

Older women have either learned “to live with it,” or their expectations are lower because their partner has also changed–such as developing erectile dysfunction–and so the couple has learned to accommodate,” added Kingsberg.

A top concern for women in the survey was a loss of interest in sex. That’s to be expected, Kingsberg said, as one in 10 women of all ages suffer from low desire. But the other top concern, inadequate vaginal lubrication, affects mostly post-menopausal women.

“Many women don’t realize menopause is not just about hot flashes and night sweats. The loss of estrogen affects vaginal tissue,” Kingsberg said. “And unlike hot flashes, which will eventually go away, those changes in the vagina and vulva don’t go away and will get progressively worse.”

That’s because the loss of estrogen actually thins the cells and tissue of the genitals, leading to a loss of sensation, loss of arousal and possible pain with penetration. But many women aren’t aware of this physiological fact of aging, or that there are medical solutions to the problem.

“Lubricants during sex can certainly help with dryness, as can daily moisturizers during the week,” said Kingsberg.”They are comfort based but don’t address tissue change. To actually restore the tissue, you need a local estrogen.”

Topically applied estrogen doesn’t have the same medical concerns as oral, systemic estrogen, said Kingsberg, yet only 7% of women suffering from vaginal dryness and pain are on a medication. Part of the reason, the survey found, could be because the majority of women said they were not discussing their symptoms with their doctors. Of those who do, 70% had to initiate the conversation.

“That is very disturbing,” said Kingsberg. “If your physician is not asking you about sexual concerns, find another one. It’s too important. There are many treatment options available today, and it’s absolutely essential women should be talking about this with a doctor. Women should not have to figure this out on their own.”

Kingsberg recommends older women find a menopause certified practitioner by using the find-a-provider tool on the website of the North American Menopause Society or the International Society for the Study of Women’s Health. Health care providers there have been trained in the changes aging brings to the female body, and are more likely to open the door to communication.

“There’s still this double standard,” Kingsberg said. “Women are told it’s all in your head, it’s all psychological, you don’t need a pill or other treatment.

“But the fact is that it is the same as with men. There are biologic factors and psychological factors and women deserve treatment options and to be able to talk to their doctor about what’s the best option for them.”

The study was funded by Nuelle, Inc., a maker of female intimate care products, and administered by an outside survey company.