Menopause and sexuality.

Heard the rumors about menopause and losing sexual desire? Don't believe them. Sex and desire don't stop when your periods do.

**********

"Women aren't buying into the myth that sex ends with menopause," says Sheryl A. Kingsberg, PhD, associate professor at Case Western Reserve University School of Medicine in Cleveland. "They fully expect to maintain their good health, which includes all their premenopause activities, including sexuality. Their image of a postmenopausal woman is youthful, sexual, sensual, energetic and successful."

In fact, focus groups held by the National Women's Health Resource Center (NWHRC) and the Association of Reproductive Health Professionals (ARHP) in late 2004 found that menopausal women are comfortable with their sexuality and the idea of being sexually fulfilled, that they enjoy feeling desirable and being intimate. (8)

Menopause might even be a time during which sexual satisfaction, if not desire, increases, says Jill P. Wohlfeil, MD, an ob-gyn who practices near Milwaukee. "Sexually, things start to even out because men are finally OK with not having sex all the time and are starting to have some issues with sexual dysfunction and erections. I think they find more joy in the intimacy of the relationship." Plus, she notes, for many women with older or grown children "and with the guy realizing he's not 20 anymore, a lot of stressors are gone, so women have more emotional energy to drive that intimacy cycle."

But what about the vaginal dryness and hot flashes? "Those are things I can fix so easily with hormone therapy and other medical and lifestyle treatments that within two weeks women see a huge difference in their sex lives," says Dr. Wohlfeil.

And that plummeting testosterone level? Another myth. Even though estrogen and progesterone levels drop suddenly in midlife, testosterone doesn't. It's been declining steadily since a woman's 20s and the decline doesn't "speed up" as you move through menopause.

In fact, women may get a slight boost in "free" testosterone, that is, testosterone that circulates freely in the blood-stream where it can bind to cellular receptors. Normally, most testosterone is bound up with estrogen, making it useless. But less estrogen means more free testosterone, which means more of the hormone is available to tweak libido, says Dr. Wohlfeil.

In the NWHRC/ARHP focus groups, which included approximately 45 menopausal Caucasian, African-American and Hispanic women, participants said that:

* Sexual side effects of menopause (vaginal dryness and decreased libido, for instance) are not top of mind, but they are part of a broader discussion of menopause.

* Sexual side effects of menopause have a physical and an emotional component. In other words, the physical sexual side effects affect women emotionally, inhibiting their sex drive, which then impacts their sexual relationships.

* For some, declining sex drive is not a negative development; rather, it is just something that comes naturally with age. As one woman said: "My life is very comfortable. I'm in a mode where I'm thinking about changing careers. My sons are away at college and my husband and I are kind of reconnecting and it's just really good. I mean, we're at a nice place."

But you can't ever forget the crux of any good sexual relationship: the relationship itself. As Dr. Wohlfeil notes, "We find that in a healthy relationship at perimenopause and menopause, [sexual] things tend to get healthier and in the bad relationships, [sexual] things tend to fall apart."