Medical Treatment for Sexual Problems in Menopause
Women in menopause and postmenopause may experience symptoms such as vaginal dryness and decreased libido (sexual desire).
If the sexual problem is caused by a medical or physical problem, your health care provider or consulting specialist will suggest an appropriate treatment plan. This will vary, of course, depending on the nature of the problem. The plan may include medication, lifestyle changes, or surgery. Your health care provider may recommend counseling, even if the problem is physical.
Not all women experience symptoms prior to or following menopause, which is defined as the time when a woman has naturally ceased having menstrual periods for one year. If menopausal symptoms occur, they may include hot flashes, night sweats, pain during intercourse, increased anxiety or irritability, and the need to urinate more often.
Effective therapies are readily available for some physical problems. They include:
Vaginal lubricants -- These products are highly recommended for women with vaginal dryness. They can be bought in a drugstore without a prescription. They are available as creams, gels, or suppositories. Water-based products are the best choices. Oil-based products such as petroleum jelly, mineral oil, or baby oil can interact with latex condoms and cause them to break.
Topical estrogen -- These products can help make sex more comfortable for menopausal women with vaginal dryness or sensitivity. Estrogen is applied as a cream or vaginal insert. These products are available by prescription and are very effective for some women.
Clitoral therapy device -- The Eros clitoral therapy device has been approved by the FDA to treat women with disorders of sexual arousal. The device consists of a small suction cup, which is placed over the clitoris before sex, and a small, battery-operated vacuum pump. The gentle suction provided by the vacuum pump draws blood into the clitoris, increasing pressure on the clitoral nerve. This device increases lubrication, sensation, and even the number of orgasms in many women who have used it. The device is available by prescription.
Drugs -- Viagra is the well-known "erection drug" for men. It is used to treat erectile dysfunction, a common sexual problem among men. No similar drug is yet available for women. The effects of Viagra in women have been studied, but results are not conclusive. In some studies, the drugs helped with arousal problems, but in another important study, they did not. The drug has the same side effects in women as in men, including headache, flushing, nasal congestion and irritation, abnormal vision, and stomach upset. It can worsen retinitis pigmentosa, a hereditary degenerative disease affecting the eye. Most importantly, it can cause dangerously low blood pressure and has been linked to unexplained heart attacks in men. Viagra cannot be taken by people who take a nitrate drug for a heart condition, because the combination can be deadly. Another drug, Osphena, makes vaginal tissue thicker and less fragile, resulting in less painful sex for some women. Osphena -- taken orally once a day -- can thicken endometrium (the lining of the uterus) and raise the risk of stroke and blood clots.
Hormone replacement therapy (HRT) has been used to relieve symptoms of menopause, including vaginal dryness, for years. However, research has shown some risk in using hormones. A rundown:
HRT comes in two forms, estrogen only (ERT) and combination estrogen-progestin, a synthetic form of the hormone progesterone (HRT). ERT generally is used for women who have had a hysterectomy, while HRT is used for women who still have their uterus, because the progestin protects the uterus from the effects of too much estrogen, especially uterine cancer.
For many years, HRT was believed to have many beneficial effects for menopausal women, continuing the protective effect that estrogen provides naturally before menopause. These benefits were thought to include protecting against heart disease, high cholesterol, colon cancer, Alzheimer's disease, and osteoporosis. Later research called these beliefs into question. Long-term use of HRT or ERT was linked to significantly higher risks of breast cancer, heart attack, stroke, and blood clots (from one kind of HRT). The research did show that HRT protects against osteoporosis and colon cancer, but the risks are considered to outweigh the benefits.
Using data from the Women’s Health Initiative, the U.S. Preventive Services Task Force (USPSTF) in May of 2012 recommended against using hormone replacement therapy to prevent chronic diseases, including osteoporosis, dementia and heart disease. They weighed any benefits that the hormones may have with their risk of increased heart disease, increased gallbladder disease, slightly increased risk of dementia, and increased breast cancer. However, the task force noted that recommendations do not apply to postmenopausal women who are considering using HRT to manage vaginal dryness and hot flashes.
Each woman's need for HRT and risks in taking HRT are unique to her. These should be discussed in detail with your health care provider.
Use of HRT in menopausal women is now considered on a case-by-case basis.