Loss of Libido
“With all sexual issues, good communication between partners is always important.”
Sexual feelings and activities are a natural part of living. Many women remain sexually active throughout their postmenopausal years. In general, sexual desire (sex drive) decreases with age in both sexes, but each individual is different.
Although some experience a significant decline in desire, a few have increased interest, and others notice no change at all. Research shows, however, that sexual problems are common for both women and men of all ages, with women being two to three times more likely than men to be affected by low desire. Low sexual desire is especially common in relationships of long duration.
Menopause & Sexual Desire
The relationship between menopause and sexual desire continues to be studied. Reduced ovarian production of estrogen at menopause can contribute to hot flashes and night sweats, robbing a woman of restful sleep and reducing her interest in having sex. Falling estrogen levels can also result in vaginal dryness, making intercourse uncomfortable. At the same time, the body’s production of another hormone— androgen—declines with age, possibly decreasing desire.
Women who experience early menopause are at an age when they sometimes enjoy frequent sexual activity and may be more disturbed by any sexual function changes than older women. In today’s youth-oriented society, women who have reached menopause may fear rejection by their partner. Women without a partner may feel as if they can no longer “compete” with their same-age peers, now that they have reached menopause. In addition, women who undergo cancer treatment often have additional emotional concerns that may affect their sexual desire.
In the cases of Induced Menopause
Women experiencing induced menopause caused by removal of both ovaries or by chemotherapy have an accelerated decrease in both estrogen and androgen levels. This may have a more negative effect on sexual function than spontaneous menopause. Many women are surprised to learn that androgen, primarily considered a male hormone, is also produced in females. However, levels in women are about 10% of those in males. In women, the ovaries and adrenal gland above the kidneys secrete androgen, primarily as testosterone. Aging ovaries produce less androgen, although the decline is not as steep as with estrogen. However, the following conditions result in lowering androgen more quickly: surgical removal or damage of one or both ovaries before spontaneous menopause; pituitary and adrenal insufficiency; steroid therapy; oral contraceptives or estrogen or estrogen-progestogen therapy (ET/EPT); and some chronic illnesses.
Although removal of the ovaries or ovarian damage caused by chemotherapy or radiation may result in decreased androgen levels, some women continue to produce androgen from the adrenal gland. In addition, androgen levels generally do not correlate with sexual satisfaction. Many young premenopausal women with high androgen levels have many sexual concerns, while many older ostmenopausal women with low levels remain very satisfied. The principal predictors of a satisfying sexual life include physical health, psychological well-being, and the quality of the relationship—not a woman’s androgen level.
Causes of Loss of Libido : Induced Menopause
Loss of sexual desire may be caused by several reasons:
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Surgery-Induced Menopause.
Sexual function after surgery-induced menopause may be affected by a range of other factors, including pain or fear of pain (on the part of the woman and her partner). Women may also experience a loss of sexual desire due to the abrupt decline in androgen levels after their ovaries are removed.
Additionally, a woman may feel unattractive and avoid initiating sexual encounters after a surgical procedure such as the removal of a breast or uterus. Likewise, her partner may avoid intercourse, fearing that sexual activity will cause her pain. Other issues, such as stress and fears or preoccupation with long-term health, can have a tremendous impact on sexual desire. Also, problems with vaginal lubrication can lead to painful intercourse and avoidance of subsequent sexual activity.
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Hysterectomy
Hysterectomy does not always affect sexual function, although some women may notice a slight change in sensation during intercourse and/or orgasm. Women and their partners need reassurance that removal of the uterus does not mean losing sexual desire and femininity. In fact, many women have improved sex lives after hysterectomy due to relief from pain, uterine bleeding, and fear of pregnancy. However, hysterectomy may interfere with blood flow to the ovaries, resulting in decreased function and lowered levels of estrogen and androgen.
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Chemotherapy-Induced Menopause.
The side effects of chemotherapy—including extreme fatigue and nausea—can dramatically reduce sexual desire. It is difficult for a woman to feel sexual when she doesn’t feel physically well. Additionally, some chemotherapy drugs irritate the vaginal lining, leaving it dry and inflamed. Temporary weight changes during chemotherapy, as well as temporary hair loss and other physical changes, can negatively impact a woman’s body image, making women feel less comfortable about intimacy with a partner.
Depending on the extent of the ovarian damage caused by chemotherapy, the ovaries may continue to produce low levels of androgen after treatment. If androgen levels decline significantly, however, women may experience a loss of sexual desire, although the ability to obtain pleasure from touching remains. In some cases, intimacy takes on a new meaning. Partners may feel closer to each other and can experience pleasure and comfort from touching and cuddling.
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Pelvic Radiation-Induced Menopause.
During pelvic radiation treatment, some women are advised not to have intercourse. However, most women are able to resume sex within a few weeks after treatment. Women and their partners sometimes discover new intimacy as they continue to find pleasure in touching and cuddling, and explore new ways to be close until (and after) intercourse is resumed. As with chemotherapy, the extent of the ovarian damage caused by radiation determines if the ovaries are able to continue to produce low levels of androgen after treatment.
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Other Factors Affecting Desire.
Hormone changes are only part of a complex group of factors that influence sexual function at menopause and beyond, regardless of when menopause occurs. Fatigue and stress can dampen sexual desire. Some women report difficulty being aroused or reaching orgasm.
Other factors include changes in body image and self-esteem, as well as concerns about aging and feelings about sex outside of the reproductive situation. Sexual interest also depends on the quality and meaning that sexuality has always had for a woman.
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