There are many difficult discussion topics for women who are in the years leading up to their last menstrual period (perimenopause), and for women who have completed their periods (menopause or post-menopause).
In my practice, I have found that shared medical appointments (SMAs) can be very beneficial for women who want to discuss menopause and its effects. The format of a shared medical appointment is valued by many women, as it combines their regular, private exam from their doctor with a group discussion with other women experiencing the same symptoms and challenges. Women realize they are not alone in what they are feeling or experiencing, and they can hear ideas and solutions from other women like them in a safe and open environment.
At our group appointments, we discuss a number of topics and concerns, from the physical and emotional changes women experience, why these happen, and how we can improve our quality of life through education, behavioral changes, and perhaps medications.
One of the most challenging issues for women is the loss of their libido, or sexual interest and responsiveness. Women often say, “Everything is lower and slower.” In a typical SMA conversation about libido, I try to guide women through a process of assessing what things were like before perimenopause and what might have changed – physically, environmentally, psychologically – in order to help them identify things they might do to regain their libido.
During the group session of the SMA (and perhaps one-on-one with a woman during her private appointment with me), I address a number of factors that can affect the libido, such as changes in a woman’s relationship with or sexual attraction to her partner; the impact of the normal stresses of caring for children or teens, or maybe the additional stress of caring for elderly parents; medical issues for either partner that impact self-esteem or interfere with sex; or perhaps a sense that sex is boring and predictable. Studies show that a woman with low libido will often have a dramatic increase in libido if she finds a new partner, which even in a monogamous relationship indicates that novelty and new approaches are important in maintaining a satisfying sexual life.
We live in a culture where women are expected to juggle so many things and still feel sexy and responsive! Listening to women talking about these topics in the SMA, it becomes increasingly clear that for women, the most important sexual organ is the brain, and this organ needs a lot of attention, particularly at a time of life when so much is usually happening.
We also discuss the pros and cons of hormonal therapy, (estrogen and progesterone), the controversial role of testosterone therapy, and the use of local vaginal estrogens to improve vaginal lubrication (as well as the use of over-the-counter lubricants like KY Jelly or Astroglide, and moisturizers like Me Again or Replens.) We also discuss how to help reluctant partners talk with their own doctors about their particular issues.
We talk about the importance of setting aside time with a partner to be intimate, to date, to do something unexpected. Finding joy and playfulness is another important element that is often overlooked.
I encourage women to think about all the different elements we have reviewed and to understand that as we age, instead of feeling aroused and then wanting sexual relations, many women find that they need a different order of things: start with a nice massage, warm bath, or pleasurable touch, and then the arousal kicks in.
Having an open discussion is often the first step in improving a woman’s sexual life and her ability to be aroused. Learning to communicate openly and without blame with a partner is extremely important; sometimes, working with a clinician trained as a sexual therapist can be very helpful.
I also believe that reading can be both educational and the beginning of a more open conversation. Here are some books that woman have found helpful, and I also recommend this information from the National Menopause Society website.
Booklist
- My Secret Garden by Nancy Friday
- Illustrated Manual of Sex Therapy by Helen Singer Kaplan
- Getting the Sex You Want: A Woman’s Guide to Becoming Proud, Passionate and Pleased in Bed by Sandra Leiblum & Judith Sachs
- Making Love the Way We Used to…OR Better: Secrets to Satisfying Midlife Sexuality by Alan Altman & Laurie Asher
- Becoming Orgasmic: A Sexual and Personal Growth Program for Women by Julia Heiman & Joseph Lopiccolo
- The New Love and Sex After 60 by Robert Butler & Myrna Lewis
- For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfuntion and Reclaiming Your Sex Life by Jennifer Berman and Laura Berman
