Effects of Menopause on Sexual Functioning

Introduction:

Hormones are known as chemical messengers of the body. Various physiological functions are regulated by hormones. Not only that our phycological behaviors are also controlled by hormonal action. Female sex hormones play a crucial role in various processes like reproduction, physical appearance, psychological behavior, and sexuality. After menopause, a rapid change takes place in the female body due to the change in the physiological process. This change is associated with altered behavior and sexuality of the women.

What Is Menopause?

The cessation of the menstrual process is known as menopause. For menopausal women, the spontaneous menstruation process is absent for more than 12 months. The usual age for women to attain menopause is between 49 to 52. But this age may vary from person to person on the basis of various factors like racial and environmental factors. Usually, women attain their menopause after the age of 45. Other than this, surgical removal of the uterus, and tumor may cause sudden menopause.

What Is the Mechanism of Menopause?

The functional unit of the female reproductive system is known as the ovarian follicles. During birth, the number of follicles is almost 400000. But with increasing age, the number of follicles is reduced. At puberty, the number of remaining follicle remain are about 200000 to 300000. During each menstrual cycle, about 30 follicles are recruited and among them, one becomes the dominant follicle. Gradually the number of follicles are decreased due to ovulation and degeneration. The mature follicle is known as the Graafian follicle. The Graafian follicle is responsible for the secretion of various hormones like estrogen and progesterone. The function of these hormones is the maintenance of various reproductive functions.

Due to the decreasing number of Graafian follicles less inhibin B is produced. This substance is associated with the regulation of follicle-stimulating hormone (FSH). As a result, the level of FSH is increased and more follicles are matured. This causes acceleration in the depletion of follicles. Ultimately the level of estrogen is decreased and the level of follicle-stimulating hormone is increased. Not only that the level of luteinizing hormone (LH) is also increased. In the blood, the concentration of serum sex hormone-binding globulin (SHBG) and dehydroepiandrosterone sulfate (DHEAS) is decreased. As a result, the concentration of testosterone is decreased. Also, due to the stoppage of ovulation, the amount of progesterone is also reduced in the blood.

What Are the Effects of Hormones on Sexuality?

The effects of hormones must be understood before evaluating the effects of menopause on sexuality. The sexual activity of women can be divided into four phases. The first phase is sexual arousal. In the next phase, vaginal lubrication and relaxation of the clitoris and vulva occur due to the increased blood inflow. This increased blood flow triggers orgasm which is considered the peak phase of sexual activity. Following this relaxation occurs which is defined as a slower resolution phase.

These events are aided by blood capillary changes and changes in nerve neurotransmission. Estrogen and testosterone play a pivotal role in the regulation of such functions. Estrogen maintains blood perfusion and helps in neurotransmission. The level of testosterone is associated with the desire for sex and sexual arousal. Alteration in the level of such hormones is associated with a change in sexual behavior.

What Are the Effects of Menopause On Sexuality?

The effect of menopause on sexuality is numerous. Several changes in sexual activity and its function is noticed during this phase. These changes are:

1. Hypoactive Sexual Desire Disorder- This is characterized by a low sexual drive and desire. A low level of testosterone is associated with such conditions. In this condition, symptoms like lack of sexual thoughts, fantasies, or desire for or receptivity to sexual activity can be seen. Women often complain of poor self-esteem, lack of self-confidence, and psychological instability. This is mainly caused by low levels of testosterone hormone.

2. Symptomatic Vulvovaginal Atrophy: Change in the normal philosophy of the vulva is one of the distinctive features of menopause. A reduced level of estrogen is associated with this. The normal level of estrogen maintains the balance of microorganisms in the vaginal tissues. Alteration in the level of estrogen associated with this condition is characterized by a decrease in lactobacilli count in the vagina. As e result, the vaginal pH balance of tissue becomes acidic. The vagina appears thin, pale, and dry. Patients complain of dryness, itching, and burning sensations.

3. Orgasmic Dysfunction: Orgasmic and arousal dysfunctions are very commonly seen in post-menopausal women. Women find difficulty in attaining orgasm after sufficient sexual stimulation. Also, they find difficulty in attaining or maintaining sexual excitement. This is associated with dissatisfaction after sexual activity.

4. Pelvic Organ Prolapse (POP): This is a rare condition caused by the degeneration of muscles and connective tissue supporting the pelvic structure. Aging and altered metabolic activity caused by hormonal imbalance is responsible for this condition. This is associated with the altered positioning of the anterior vaginal wall, posterior vaginal wall, uterus, or apex of the vagina. Often these organs are bilged out from the vagina.

5. Pain during sexual intercourse. The pain may persist even after having sex.

6. Involuntary contraction of vaginal muscles can be seen due to dysregulation of the neurotransmitters.

7. Thinking of the hair, and excessive weight gain is caused by menopause. Some women experience a reduction in breast size due to the loss of glandular tissues and decreased estrogen levels. On the other hand, some may complain of an increase in breast size due to weight gain.

What Are the Preventive Methods?

In most cases, menopause is a result of physiological changes in the reproductive system. But a healthy lifestyle, cessation of smoking and drinking, and regular exercise are essential for physical and psychological health. Also, the ill effect of hormonal dysregulation can be averted by these procedures.

• Psychological counseling can be useful for the treatment of sexual dysfunction.

• Hormonal replacement therapy can also be used for the treatment of sexual dysfunctions and other post-menopausal symptoms. A combination of estrogen and progestin (synthetic progesterone) is prescribed to the patients in such cases. Also, testosterone formulations can be given to patients with sexual dysfunctions.

Conclusions:

Menopause is associated with several hormonal changes in the female body. In most cases, women suffer from conditions like a low sexual drive, sexual dysfunctions, and abnormalities of sexual organs. Such changes can be counted by a healthy lifestyle and physical activity. Also, psychological counseling and hormonal replacement are very important for the treatment of sexual dysfunctions.