Commonly asked questions about sex.

Q My doctor keeps telling me that it's natural for a woman my age to lose sexual desire, but I miss it. Can this problem be treated?

A Some women at menopause or with aging have a decline in desire, just as some men do. Some women do not. It is a complex issue involving changes in hormone levels, possibly changes in health status as well as relationship quality, and the pressurized lives most women lead, leaving little time or energy for intimacy. Given the multiple issues that may be at play, there are no quick fixes for a decrease in sexual interest. If your physician isn't willing or able to discuss the issue with you in more depth, then you should ask if there is someone he or she recommends with whom you can discuss this issue that is so important to you.

Q Are there tests that can show if my sexual problems are physical, emotional or a combination of the two?

A There is no "test" for desire or lack of desire. Your health care professional must take a careful medical and social history because certain health conditions and medications can cause changes in sexual function and desire. For instance, some women who have had their ovaries removed note that they have an immediate drop in desire after this "surgical menopause." Some improve their desire with menopausal hormone therapy, including estrogens and testosterone. Unfortunately, however, there is no "blood test" that can define who will respond to hormones. Some women with low ovarian hormones do not improve with menopausal hormone therapy while many women with very low hormones have normal levels of desire.

--Kirtly Parker Jones, MD

Professor, Department of Obstetrics/Gynecology University of Utah Health Sciences Center Salt Lake City, UT

Q I deeply love my husband, and find him incredibly attractive and sexy. Yet every time we start to make love, it hurts horribly. Why?

A There are many physical problems, like chronic vaginal infections, that can make sex difficult. Another is vulvodynia (or vulvar vestibulitis), which is a dramatic inflammation causing terrible pain at the opening of the vagina where the penis enters, making sex extremely uncomfortable. This is a common condition, affecting an estimated one in 15 women, and it is often misdiagnosed as low desire.

If your problem is vaginal dryness--another problem that can cause painful intercourse and that may occur as estrogen levels start to fall--there are various types of estrogen creams and ring inserts that can be used. You should also be evaluated for chronic illnesses such as diabetes, which affects blood flow and nerve conduction to the genital area, any kind of nerve disorder, such as multiple sclerosis, and anything that affects the muscles of the pelvic floor, such as uterine prolapse.

--Susan Kellogg-Spadt, CRNP, PhD

Director, Sexual Medicine

The Pelvic & Sexual Health Institute Philadelphia, PA

References

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3 Advisory Committee For Reproductive Health Drugs transcript, December 2, 2004. US Food and Drug Administration. Available at: http://www.fda.gov

4 American Association of Retired Persons. Modern maturity sexuality study. Available at: http://research.aarp.org/health/mmsexsurvey.pdf. 2005.

5 Kingsberg S. Just Ask! Talking to patients about sexual function. Sexuality, Reproduction 6 Menopause. 2004:2(4)

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7 Solursh DS, Ernst JL, Lewis RW, et al. The human sexuality education of physicians in North American medical schools. Int J Impot Res, 2003 Oct; 15 Suppl 5:S41-5.

8 Sexual Side Effects of Menopause [report]. Association of Reproductive Health Professionals and National Women's Health Resource Center. December 17, 2004

9 McCarthy BW, McCarthy EJ. Rekindling Desire: A Step by Step Program to Help Low-Sex and No-Sex Marriages. New York, NY: Brunner-Routledge; 2003.

10 Laumann, E. O. 2000. Sex, Love and Health in America: Private Choices & Public Policies Robert T. Micheal: Chicago.