Sexual Wellness

Intimacy is Possible After Menopause

February 20, 2023

By: Rachel Noonan, PharmD

Menopause is no stranger to sexual dysfunction. Its slow and steady build is surprisingly pervasive.  Symptoms cast in a supporting role end up taking the lead. Sexual problems can be hard to talk about. Which is why many patients don’t.

Vaginal atrophy is just the beginning. Localized dryness can contribute to painful intercourse. Libido declines while your patients find sexual intimacy less enticing. The REVIVE (Real Women’s Views of Treatment Options for Menopausal Vaginal Changes) survey revealed 59% of postmenopausal patients experience decreased enjoyment of sexual activity due to symptoms. Underdiagnosed and undertreated, sexual health often gets buried beneath less complicated concerns.

These progressive issues require attention. Menopausal sexual dysfunction generally stems from steep estrogen decline. Estrogen optimization can

  • Thicken the vaginal mucosa to promote healthy tissue
  • Improve vaginal secretions and circulation to address dryness
  • Lower vaginal pH to restore natural flora

It’s reported that once estrogen therapy is on board, nearly all patients experience a level of symptom relief. Months of vaginal distress or sexual upset may show improvement after mere weeks of hormonal alignment. Consistent therapy is essential.

How to paint a picture of sexual health? Different strokes for different folks.  Not all sexual dysfunction therapies begin and end with estrogen.

Dehydroepiandrosterone (DHEA) metabolizes into sex hormones, activating these receptors along the vaginal wall with local administration. Daily dosing may translate to healthier vaginal epithelium and decreased sexual pain.

Testosterone is considered the hormone of sexual desire. It’s thought to act on dopamine pathways in the brain, affecting receptivity and intimate interest. When optimized, it can positively impact sexual function and limit distress.

Oxytocin can enhance intimate feelings, sensitivity, and openness to sexual activity. Systemic options have great promise addressing libido fluctuations. Targeted vaginal formulations may reverse tissue decline.

Age related hormonal changes can negatively impact sexual health. From localized therapy to systemic options, you and your patients deserve unparalleled support. Many patients discontinue vaginal therapy after a few months. Reasons range from irritating dosage forms to frustrating discharge. That’s where customizable compounds come in, designed to fit individual need. When hormonal unpredictability goes up against therapeutic adaptability, it’s no contest.


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