You Can Still Feel Sexy After Menopause

Vaginal atrophy in post menopausal women common but undiscussed

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Has your sexual appetite gone down after menopause because of vaginal pain and discomfort? Is your intimate relationship suffering? Don't fret. You're not alone, and it can be treated!

When women experience a sharp decrease in the hormone estrogen after going through menopause, they can develop a condition called vaginal atrophy. This condition can make it difficult, painful and even embarrassing for post-menopausal women to have a healthy sex life with their partner.

A recent study looked at the physical and emotional effects of vaginal atrophy on both women and their partners. The researchers found that women were often self-conscious or cautious about engaging in sexual activity, unbeknownst to their male partners. 

The study concluded that vaginal atrophy disproportionately affects post-menopausal women's intimate relationships and self-esteem. However, local estrogen therapy was found to help many women overcome these intimacy and self-esteem issues.

"See a gynecologist if you have vaginal discomfort."

Researchers from multiple institutions in North America and Europe conducted the study under the supervision of Novo Nordisk, a global healthcare company specializing in hormone replacement therapy. They used a survey entitled Clarifying Vaginal Atrophy's Impact on Sex and Relationships (CLOSER).

The goal of the study and survey was to measure and understand the impact of vaginal discomfort, both emotionally and physically, for North American post-menopausal women who were in an intimate relationship with a male partner.

The women's male partners were also surveyed to create a full picture of the impact of vaginal discomfort on partner intimacy. This is the first study of its kind to survey male partners. 

Participants were pulled from the US, Canada, UK, France, Italy, Sweden, Norway, Denmark and Finland in order to make cultural comparisons to see if part of the problem is the way we talk about menopause, vaginal atrophy and local estrogen therapy (LET).

In LET, estrogen is applied directly to the vagina in order to improve dryness and other symptoms of vaginal atrophy. In contrast to hormone replacement therapy (HRT), which sends hormones throughout the entire body, LET exposes patients to much lower doses of hormones, which reduces the hormone's effects on other organs.

The study involved 4,167 post-menopausal women. They had to be between the ages of 55 and 65, be married or living with their male partner, be one or more years past the end of menstruation and have experienced vaginal discomfort associated with vaginal atrophy. The study also included 4,174 respondents that were male partners of post-menopausal women who suffered from vaginal atrophy.

The CLOSER survey was given online. It gathered information on the demographics of the participants, and considered the effect of vaginal discomfort on partner intimacy and relationships, as well as the impact on women's self-esteem. It also asked about LET in order to see if women had used or considered it within each culture.

Vaginal discomfort was characterized by dryness, itching, burning or soreness in the vagina, bleeding during intercourse, pain during urination or pain with touching and/or intercourse. 

The CLOSER survey found that vaginal discomfort had an overall negative impact on North American post-menopausal intimacy that was worse than researchers had expected. 

More than half the North American women surveyed reported that they intentionally avoided intimacy due to vaginal discomfort. And an even higher percentage (68 percent) reported experiencing a loss of libido all together.

More than three quarters of the male partners surveyed responded that they thought vaginal discomfort was the reason their partners were avoiding intimacy. A little over half realized that the discomfort led to a loss of their partner's libido.

Overall, about one third of the women reported that they had stopped feeling attractive and that they had stopped having sex at all with their partners.

Only 6 percent of male partners were less attracted to their partners, but almost one quarter thought that their partners felt less attractive.

North American women were more likely to use gels and creams for treatment, and less likely to use LET. The women who had used LET reported that they found sex less painful and had better self esteem about intimacy. Approximately one third of North American LET users also reported feeling optimistic about their future sex lives, and feeling more connected to their partners.

More women were likely to use LET in Europe.

The researchers also found that the use of LET in North America is not as well researched or discussed. This argument echoes the participants' opinions that post-menopausal health is not discussed as much as men's health.

Many North American women felt that society does not focus very much on menopause issues because menopause and vaginal atrophy are seen as a consequence of getting older.

The CLOSER survey confirmed the significance of a healthy and satisfying sexual relationship in old age because self-esteem, social connectedness and relationships all contribute to healthy aging.

The researchers hope that this study will start an open conversation about vaginal atrophy, possible treatments and post-menopausal sexual health in general — between partners and the health community at large.

According to these researchers, further studies are necessary to investigate exactly why North American women have a significantly worse experience with menopause and vaginal atrophy as opposed to European women. 

There were some limitations to this study because the researchers used an online sample of women who self-reported having vaginal atrophy, and men who reported their partners had vaginal atrophy.

Also, the sample size was limited to people who had internet access. Some surveys were also returned incomplete or with unclear answers. The researchers also threw out other surveys if it was evident that the person sped through the survey, the person purposely zigzagged or straight-lined through questions asked in a grid, the person gave contradictory answers, they over-clicked or under-clicked, they answered too many questions with "do not know" or "none of the above", personal information like age and sex did not match with their registration information or they selected a lot of items that typically don't happen together.

This observational study was published online in the June edition of Menopause, the journal of The North American Menopause Society.

Novo Nordisk provided funding for the CLOSER survey.

Review Date: 
June 23, 2013
Last Updated:
September 6, 2013