Mid-Life Sexual Concerns

Studies show that approximately 40% of women have difficulties with sexual functioning, and that the incidence of sexual problems is highest in women between the ages of 45 and 64. The most common sexual problem experienced by women at midlife is a loss of libido, or sexual desire. There are more than a dozen factors involved in healthy sexual functioning in women, including but not limited to changes in hormone levels.

Declining estrogen levels during perimenopause often result in vaginal dryness and consequent pain with intercourse. The pH of the vaginal secretions also changes from acidic to alkaline, which may make vaginal infections more likely to occur. Vaginal dryness and pain with intercourse may influence a woman’s willingness to be sexually active, with the end result being a loss of desire. Both hormonal and nonhormonal options are available for the treatment of vaginal dryness and pain with intercourse.

Testosterone levels also decline (in women as well as men) with age. Some studies show that a woman’s level of sexual interest is correlated with testosterone levels; others studies do not find such a relationship. In situations where the sole cause of decreased libido is thought to be a decreased testosterone level, supplementation with testosterone (obtained through a compounding pharmacy) may be helpful. This form of therapy can be safely administered with low doses of testosterone, and requires careful follow-up to make certain that blood testosterone levels are maintained within the normal range for women.

Dr. Clark has a long-standing interest in midlife sexual issues, and has provided significant help for her patients who are dealing with these. The process starts with a comprehensive history and physical examination, followed by appropriate laboratory testing. A treatment plan that respects the patient’s preferences can then be initiated. In the event that hormonal insufficiency is felt to significantly contribute to the problem, biologically identical (bioidentical) hormone therapy is given under close supervision.