Midlife and older women grew up in a wonderful era.  If you were a part of the 60’s and 70’s, you were a part of an age of social consciousness, the antiwar movement, equality and respect for all races, and women’s equality.  We were also a part of, dare we say it?, the sexual revolution.  Why am I bringing this up in a medical newsletter?  Because for midlife and older women, it may be time to have a sexual revolution of our own.

As women age, many physical changes occur, usually related to decreasing hormones.  Replacing the hormones provides relief as the tissues in question can start functioning again.  There are some tissues that have more receptors for hormones and therefore need more than others.  These tissues for women are genital tissues, and they do not work very well without hormones.

Without hormone replacement, vaginal tissues dry and thin, and the cells change.  The opening in the cervix will actually “close up”.  The resultant symptoms are painful intercourse, and decreased or lack of sex drive.  The ability to have an orgasm is challenging.  This may sound similar to the sexual problems associated with aging in men.  It is.  The good news is that it is reversible!

Estrogen has been considered the mainstay to restore tissues to their previous healthy condition.  Many times the systemic estrogen from a pill, patch or gel, is not enough to provide what these cells need to heal.  Often direct application is necessary.  The options for direct estrogen to vaginal tissues are creams, tablets, and rings.

This will help to restore the vaginal tissues to their “prior to menopause” state. Topical estrogen, regardless of whether or not the woman is taking systemic hormones, has been shown to be extremely safe, possibly even for some women who have been treated for breast cancer.   However, recent information and studies have shown that even direct application of estrogen may not fully restore the genital tissues to their state of healthy sexual function.

A recent article in the Climacteric, journal of the International Menopause Society, has pointed out that there are a number of androgen receptors in the vaginal tissue, particularly in the surrounding muscles and outermost portion of the genitals.  The pelvic muscles play an important role in preventing urinary leakage.  Sometimes providing estrogen replacement can resolve this annoying symptom.  If not, testosterone therapy should be considered.

Also, painful intercourse that is not resolving with estrogen or lubrication may require testosterone.  The outermost tissues around the labia will only respond to testosterone.  It makes sense that our bodies naturally have a mixture of hormones.  Attempting to solve all the problems with one is like learning English by using one letter of the alphabet!

The final point to remember is that testosterone is also often responsible for restoring libido (interest in sex) as well as ability for sexual response including ability to achieve orgasm.

Testosterone can be taken in tiny pellets under the tongue, gel applied to the thighs, or creams or suppositories used for direct vaginal application.

Men and women both have “tools” available to restore healthy sexual functioning by using hormone replacement.  Too often I hear patients ready to accept the demise of an activity that once brought them joy and closeness to their mate; as a resignation to old age.  We may forget that a healthy sex life is a reflection of a healthy body.  Perhaps it is time for another sexual revolution!