March 27, 2020
Sexual satisfaction can become more difficult to achieve as the risk of sexual dysfunction in various forms increases with age, said Dr. John McDonald, interim chair of gynecology and obstetrics at University Medical Center. He said on average after age 50, the ovaries cease estrogen production, leaving women with a variety of problems, including hot flashes, night sweats, vaginal dryness and decreased libido.
McDonald, associate professor of obstetrics and gynecology at the College of Community Health Sciences, which operates UMC, spoke at the final OLLI Mini Medical School lecture of the spring semester.
Post-menopausal women lose 50% to 70% of their estrogen production, which can be the leading cause of their sexual dysfunction.
As women age the vagina shortens, constricts and loses moisture. Additionally, the labia lose elasticity and the genital area may become desensitized. All of these changes, and the loss of hormonal urging, can lead to less sexual satisfaction for women over age 50, said McDonald.
“To alleviate some of the physical changes of menopause, a lubricant can help in penetrative sex,” McDonald said. “I recommend an unscented variety … to avoid any irritation from chemical fragrances.”
Many women want hormone replacement therapy to manage menopausal symptoms. However, as of 2003, research has shown that HRT can increase the risk of breast cancer, heart attack and stroke, said McDonald. Some doctors may prescribe HRT, but the patient must be aware of the risks.
Estrogen creams can sometimes be a safer alternative. The cream is used daily on the vagina and can help with moisture problems as well as recurring urinary tract infections, McDonald said. The cream has less chance of causing heart attack, stroke and cancer than an HRT oral prescription.
“Women are not recommended to take HRT for more than three years,” McDonald said. “I personally, do not like to prescribe it because when cancer is a possible risk, I prefer to be cautious.”
Menopause and aging are not the only causes of sexual dysfunction. Young people can also experience it as well, McDonald said. Substance use such as narcotics, alcohol and marijuana can cause lowered libido and delayed orgasm. Anti-depressants can also have this effect.
Additionally, mental health has an effect on sexual health, McDonald said. Researchers are still learning the specifics of how it can play a role, but it is clear it has a substantial impact on an individual’s satisfaction levels.
“There are sex counselors who can help with the mental side of sexual dysfunction,” McDonald said. “Mind and body are connected closely to your overall health.”
The Mini Medical School program has been put on by faculty and resident physicians of the College since 2016. It provides an opportunity for adults and community learners to explore trends in medicine and health, and the lectures offer important information about issues and advances in medicine and research.