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· The reproductive hormones estrogen, testosterone, and, even, progesterone all increase desire.
· Oxytocin has a beneficial effect on orgasm.
· The neurotransmitter serotonin has a negative effect on sexual. desire and downstream arousal, and orgasm
· Dopamine increases desire and subjective excitement,
· Norepinephrine increases sexual excitement and orgasm
Given the age-related changes in hormonal
milieu and menstrual function that come with menopause, it is no surprise
that changes in levels of endogenous estrogens and androgens might be
related to sexual function.
1. Estrogen Deficiency and sexuality
Decreased estrogen due to various pituitary hypothalmic ovarian diseases leads to female hormone estrogen & progesterone deficiency. These hormonal deficiencies leads to genital changes. The vulva and vagina lose their thickness and vascularity. Cervical secretions as well as those from bartholin glands decrease, contributing to vaginal dryness. Changes in vaginal flora causes decreased acid production and increase pH. Vaginal atrophy and dryness may lead to pruritus, dyspareunia, and increased rates of infection.
Impaired sexual Desire is expressed as :
· Discomfort during intercourse,
· Decreased vaginal lubrication
· Greater irritation
· Anxiety may result in. pain or abdominal discomfort with both insertion and deep penetration/
· Loss of sexual interest can result by simple conditioning, as a result of significant discomfort during intercourse
Similarly chest is also sensitive to estrogen withdrawal, and postmenopausal women have decreased tactile sensitivity in their chest, resulting in greater stimulation requirements so as to achieve same sexual excitement. :
Changes in libido may result if arousal becomes more difficult because of the longer time needed for lubrication or anticipation of discomfort during coitus.
Other discomforting symptoms
Bladder and bowel problems can further cause tremendous discomfort.
The bladder" often becomes thin, atrophic.
and friable with diminished estrogen. There is a lack of elasticity and
tone of these tissues. Such changes can lead to urinary incontinence,
urinary frequency dysuria, and cystitis after intercourse, These problems
account for substantial morbidity among postmenopausal women.
3. Psychological disorders
5. Influence of concurrent diseases
Almost all major medical problems and diseases, and medications for treating them, have a significant impact on sexual function . Negative effects on desire, arousal, orgasm, ejaculation, and freedom from pan during sex can occur. Chronic disease also interferes indirectly with sexual function by altering relationships and self-image and causing fatigue, pain, and dependency.
In terms of specific conditions, cardiovascular disease, diabetes, lower urinary tract problems, breast cancer,
hysterectomy, oophorectomy, endocrinopathies, bariatric surgery, osteoarthritis, clinical depression, smoking, and
natural menopause have all been consistently found to affect female sexual health.'^ Diseases such as osteoarthritis
for example, affect mobility and reducing sexual desire. Body image and perceived attractiveness are modified by
aging and disease with a concomitant reduced desire for sexual relationships. 7 Depression has been associated with low sexual desire in 50 to 60 of untreated patients.
6. Effect of Medications on Sexual Health
Women in midlife and after, are likely to be on medication for co-morbidities . New symptoms such as decreased libido, lack of lubrication, inability to reach orgasm, and lack of interest in sexual encounters may also result due to medications.
Effective treatment for decreased female sexual health often requires addressing underlying medical condition or even hormonal change
To manage decreased female sexual health tied to an underlying medical condition:
Adjust or change medication that has side effects on sexual life
Treat underlying hormonal disorder e.g thyroid imbalance
Optimize treatment for depression or anxiety. if any
Try strategies ^or relieving pelvic pain or other pain problems
Sexual Health in women approaching .menopause or post menopause can be logically dealt with various levels:
Biologic and hormonal. Estrogens. androgens, illnesses , fatigue, and medications
Treatment linked to a hormonal cause might include:
a) Estrogen therapy: Localized estrogen therapy comes 'n the form of a vaginal ring, cream or tablet This therapy
benefits sexual function by improving vaginal tone and elasticity, increasing vaginal blood flow and enhancing
b) Androgen therapy: Androgens include male hormones, such as testosterone, Testosterone plays a role in
healthy sexual function in women as well as men, although women have much lower amounts of testosterone.
How/ever, hormonal therapy may be associated with various adverse effects like alopecia, hirsutism, hoarse voice etc (androgen therapy) or possible endometrial hyperplasia (estrogen therapy),
Lack of appropriate stimuli. From the partner, and the partners own sexual function
Lack or foreplay may lead to decrease in natural lubrication during sexual act; accordingly condition like menopause
may also be associated with lack of lubrication.
Using a lubricant can aid lubrication during the sexual intercourse,
Use of lubricant: A vaginal lubricant may be helpful during intercourse if one experiences vagina! dryness or pain
during sex. However, lubricants could be anesthetic which may decrease sensation during coitus &may be messy to use, underlines a need for a newer approach to overcome such limitations.
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