1. Sex after Menopause Jared C. Robins
Chief, Reproductive Endocrinology and Infertility
Northwestern Feinberg School of Medicine

2. Definition
Menopause is the cessation of a woman's reproductive ability, the opposite of menarche. Menopause is usually a natural change; it typically occurs in women in midlife, during their late 40s or early 50s, signaling the end of the fertile phase of a woman's life.
-Wikipedia

3. “Type a quote here.”
–Johnny Appleseed

4. Menopause- patient’s perspective
Cessation of menstrual periods
Change of life
Changing emotions
Changing body
Aging
Increased disease risks, medical care needs
Woods et al. Menopause 1999.

5. “Type a quote here.”
–Johnny Appleseed

6. Myths
Sexual activity in people over age 65 increases the risks of a heart attack
The sex urge increases with age in men
Most older females are sexually unresponsive
There is an inevitable loss of sexual satisfaction in post-menopausal females

7. Truths Prescription drugs may alter a person’s sex drive
Fear of inability to perform may cause sexual dysfunction in males
Fear of health effects may cause sexual dysfunction in men and women
Sexual activity has beneficial physical effects

8. Menopause or depression?

9. Sexual Dysfunction

12. Effect of menopause on sexual function
Sexual responsivity
Libido
Pain with intercourse
Partner problems
Sexual frequency

15. FSH
Estradiol

16. Estrogen depletion Hot flashes Sleep disturbances Vaginal atrophy
Loss of desire

18. Sleep disturbances Affect 1/3 - 1/2 of women Nocturnal hot flashes
Other causes: sleep disorders (eg. apnea), stress, chronic illness, allergies, pharma
Insomnia produces fatigue, irritability, depression
Decreased sexual desire

19. Treatments Relaxation techniques: yoga, massage, meditation Exercise
Avoid triggers - spicy food, caffeine, alcohol
Supplements - Phytoestrogens, black cohosh, red clover
SSRI
Clonidine
Estrogen

20. Sleep hygiene Lower light/noise Cool down the room
Keep a regular sleep schedule (6-9 hrs)
Use relaxation techniques
Use the bedroom only for “bedroom activities”
Avoid heavy meals, alcohol, nicotine, caffeine
Exercise daily, not close to bedtime

21. Estrogen replacement Decreases hot flashes/night sweats
Reduces sleep latency
Increases percentage of REM sleep
Improves insomnia even in the absence of flashes

22. Vaginal atrophy

23. Vaginal atrophy Loss of collagen and adiposity in the vulva
Clitoral glans loses its protective covering
Vaginal surface thinner, less elastic, more likely to blood

24. Symptoms Dryness Itching / burning
Change in structure - pressure, leaking uring
Increase in discharge
Dyspareunia - painful intercourse

25. Treatments Vaginal moisturizer and pH balancer Vaginal lubricants
Continued sexual activity /stimulation
Estrogen replacement
AVOID
petroleum-based products
antihistamine
douching

28. “Dressed to Impress”

29. Loss of estrogen impacts libido

31. Testosterone and DHEAS
Lethargy
Strength
Vitality
Sexual desire

33. DHEAS levels

38. Barriers to sexual health
Healthcare providers do not ask questions about sexual health
Lack of training
Lack of time
Not wanting to embarrass
Rooted perceptions and beliefs
Lack of Privacy in communal living

39. –Johnny Appleseed

40. “Type a quote here.”
–Johnny Appleseed

41. Conclusion Sexuality does not end with menopause
There are many reasons for a decrease in sexual function.
Discuss with doctor
Expect a referral if necessary
There a natural remedies that may be effective
Pharmacologic intervention may be useful

42. “Type a quote here.”
–Johnny Appleseed