In Need of a Passion Makeover?

By: Red Hot Mamas

Published: May 26, 2010

As Baby Boomers, most of us were part of the sexual revolution of the 60s. Our mantra, at that time, was "if it feels good, do it". Our sexuality came into the open. It was a movement that helped define our generational identity based on a shift in thinking about sex and sexuality. These days, however, our mantra could be "The times they are a-changin". Our sex life that was once creating a rush is now as thrilling as the stock market – first it’s up, then it’s down. We’re suddenly in the midst of another type of sexual revolution, especially in the area of sexual desire.

Sex is becoming a thing of the past and is disappearing almost as quickly as it appeared back in the Summer of Love. As Buffalo Springfield used to chant, "There’s something happening here, what it is ain’t exactly clear."

While we were busy liberating ourselves as young adults, we had no idea that all our sexual desire was (and still is) fueled greatly by our hormones. Testosterone is an important sex hormone for both men and women. For women, testosterone levels peak in early adulthood, then decline slowly throughout the rest of our lives. Women in their 40s have about ½ the testosterone as they had in their 20s. Women with surgically induced menopause are a little different because they experience a sudden drop in all hormone levels. When these levels drop, the "I’m not in the mood," excuse begins taking over our sex lives. Evidently, 40% of postmenopausal women (not everyone) experience low sexual desire ( Hubayter, Z. and Simon, J. A., 2008 p182).

We can’t place all the blame on our hormones though. There are psychological and social factors that can influence sexual desire as well including depression, stress, fatigue, childhood sexual abuse, assault, trauma, body image issues, relationship conflicts, etc. If you experience any libido problems, your doctor should fully evaluate all aspects of the problem, including all potential psychological and physiological ones. Regardless of the cause, the loss of sexual desire can leave us and our partners feeling frustrated, helpless and in distress.

Many non-prescription options are available to improve sexual desire and functioning including keeping a positive attitude, communicating with your partner, regular exercise and a healthy lifestyle. In the past, Red Hot Mamas has provided you with several bedroom helpers including Tips for Keeping Sex Alive at Menopause and our special report on Life Between the Sheets . Sometimes these lifestyle changes don’t completely work for some people. If you are still having problems and feel like you have tried everything, you may want to consider pharmacologic options.

Women baby-boomers have also learned that their sense of humor isn’t the only thing that is dry. Vaginal dryness is a common symptom of menopause. Less estrogen, means a decline in the juiciness of the tissues. If you are going through a dry spell, talk to your doctor about estrogen. Improvements can be achieved by using estrogen cream or a vaginal tablet in the vagina or by vaginal insertion of a ring that releases small amounts of estrogen, or a by taking an oral low dose estrogen pill. Some women taking oral estrogen may also need to take a vaginal estrogen cream or estrogen intravaginal ring, or tablet. All of these products relieve atrophic symptoms like dryness and thinning of the vaginal mucosa). Estrogen improves blood flow and lubrication and can also be effective in improving orgasm rates, clitoral sensitivity and sexual activity although it has no major effect on sexual desire when used alone. Estrogen is also useful in fighting off symptoms of menopause, i.e., hot flashes and night sweats.

Another option (after you’ve excluded all other potential factors that may be contributing to your problem) is to ask your doctor to look at your testosterone levels. If they are low, ask if you may be a candidate for trying a combination of testosterone with estrogen. Data from randomized, controlled clinical trials show testosterone therapy can increase sexual desire, sexual responsiveness and the frequency of sexual activity.

Unfortunately, no testosterone products are currently approved by the U.S. or Canada for the use of treating sexual dysfunction in women. Most products are used for men although many doctors are prescribing the off-label use of the therapy for women. Many testosterone options (pills, patches, creams, gels, sprays, etc.) are in clinical trial phases 2 and 3, meaning they may be on the market in the coming years. Here is an overview of testosterone products or combinations available or under investigation:

Forumulation Product Name Trial Status
Oral methyltestosterone (with esterified estrogens) Estratest Phase 2/3
Testosterone patch Intrinsa Phase 3
Testosterone cream Androsorb Phase 2
Testosterone gel Tostrelle Phase 2/3
Testosterone gel (plus estrogen) Libigel Phase2
Testosterone spray (metered dose transdermal system) Testosterone MDTS Phase 2
Vaginal ring No product name Phase 2

Table adapted from Hubayter, Z. and Simon, J. A. (2008)

Some side effects have popped up in clinical trials although most have not been proven to be of significant value. Only oral testosterone has shown to have a minor effect on the cardiovascular system (specifically lipid profiles) when added to estrogen. Some cosmetic side effects include hirsutism and acne although if given the appropriate dose, it is minimal. There is no worry, however, that you will suddenly wake up and look like Osama Bin Laden while taking testosterone. With low dose testosterone therapy, side effects are rare. Without a doubt, more studies are needed to evaluate the risks and efficacy of testosterone therapy but some women do very well on the therapy and it greatly helps them. Every woman is different and you may be a candidate for testosterone therapy while your best friend may not. For this reason, it is important to thoroughly discuss all risks and benefits of this and any therapy with your doctor.

The North American Menopause Society states that postmenopausal women are candidates for testosterone therapy if they present symptoms of decreased sexual desire associated with personal distress and have no other identifiable cause for their sexual problems. In contrast, the US Endocrine Society recommends against testosterone use in women primarily because there i
s a lack of studies to support safety and efficacy. While more studies are undeniably needed, current clinical trial data has proven that testosterone therapy is a reasonable and sound decision for many postmenopausal women suffering from low sexual desire.

Don’t become frustrated and don’t think a low sexual desire is just part of aging. According to a study conducted by the National Council on Aging, 70% of menopausal women believe that sex is at least as satisfying as when they were in their 40s. If it’s not, then it’s time to take action and talk to your doctor.

References

Goldstat R, Briganti E, Tran J, Wolfe, R, Davis SR. "Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women." Menopause 10:3 (2003) 90-98.

Hubayter, Z. and Simon, J. A. "Testosterone therapy for sexual dysfunction in postmenopausal women."Climacteric 11:3 (2008) 181-191.

North American Menopause Society. "The role of testosterone therapy in postmenopausal women: position statement of the North American Menopause Society." Menopause (2005) 12:496-511.

Seibel, M. "Sex and menopause: From red hot to red hot mama." Sexuality, Reproduction & Menopause 3:2 (2005) 43-44.

Wierman ME, Basson R, Davis SR, et al. Androgen therapy in women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2006;91:3697-710.

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