When are we “too old for sex”?

M. PreFontaine R.Ph. FAAFM

M. PreFontaine R.Ph. FAAFM

NEVER. Our teenagers and adult children may disagree, or at least not want to hear about it, but……more than 70% of women age 40-49, 50% of women ages 50-59, 40% of women age 60-69 and almost 25% of women age 70+ report engaging in intercourse in the last year.

However, as women age, sexual problems can occur. The most common sexual problems among women aged 50+ are: decreased libido, inadequate vaginal lubrication, and difficulty with climax. Vaginal dryness, or the more severe vaginal atrophy, can be a debilitating symptom and a major contributor to low libido. Seriously, husbands: if it is extremely painful, can you understand why we may not WANT to do it? Instead of avoiding the pain and therefore intimacy, many women are seeking treatment from their physicians.

The vaginal lining is comprised exclusively of epithelial cells. Estrogen supports a thickened and mature vaginal mucosa that has adequate blood flow and therefore sufficient lubrication. Estrogen receptors are also present in the lower urinary tract and promote sphincter tone and relaxation of the detrusor muscle of the bladder. This means vaginal issues can be the “canary in the coal mine” for bladder issues. Estrogen also maintains adequate pH, preventing recurrent UTI (urinary tract infection).

In menopause, loss of ovarian estrogen can lead to vaginal dryness and atrophy, resulting in painful intercourse. Women may also notice diminished vaginal sensation, resulting in decreased pleasure during intercourse and difficulty achieving orgasm. Concomitant problems (see the canary in the coal mine sentence above) include chronic bladder infections and urinary incontinence. While lubricants can make sexual intercourse more comfortable and/or pleasurable, it is important to remember that lubricants are palliative, not preventative.

The bio-identical hormone estradiol (E2) effectively treats the dryness and atrophic changes at low doses when applied vaginally. Commercial products such as Estring Vaginal ring, Estrace Vaginal cream and Vagifem tablets contain estradiol. Other bio-identical hormones such as Estriol (E3), Testosterone and DHEA (dehydroepiandrostenediol) have also been used clinically alone or in combination in low vaginal doses to treat these issues.

A typical treatment protocol is application of the chosen hormone cream inserted into the vagina nightly for a specific period of time (2-6 weeks) or until symptoms resolve, and then decreasing application to 2-3 times weekly for maintenance. If pain is causing unwanted choices limiting intimacy, talk to your physician about treatment options.

Bachmann GA, Nevadunsky NS. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician 2000;61:3090-6.
Chism LA. Overcoming resistance and barriers to the use of local estrogen therapy for the treatment of vaginal atrophy. Int J Womens Health. 2012; 4: 551-57.
Hustin J, Van der Eynde JP. Cytologic evaluation of the effect of various estrogens given in Post-menopause. Acta Cytologica. 1977; 21: 225-28.
Leiblum S, et al. Vaginal atrophy and the postmenopausal woman: the importance of sexual activity and hormones. JAMA 1983;249:2195-8.
National Survey of Sexual Health and Behavior (NSSHB). Findings from the National Survey of Sexual Health and Behavior, Centre for Sexual Health Promotion, Indiana University. Journal of Sexual Medicine, Vol. 7, Supplement 5.
Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Eng J Med. 1993; 329: 753-56.
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2 Responses to When are we “too old for sex”?

  1. Esta Katt says:

    Is the cream applied to the inside of the vagina or around the entrance? Will this help with incontinence?

    • Mary PreFontaine, R.Ph. says:

      Several Urologists in the Grand Rapids area will tell their patient to apply the cream to the vaginal opening with their fingertip, whereas others will use the cream with a vaginal applicator. Both are effective clinically. Many patients have reported an improvement with urgency, frequency and stress incontinence. Usually the Urologists will use the vaginal creams in combination with physical therapy for the incontinence.
      Thank you for your questions.

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