Low Libido? Blame Aging
The expert: Mary Jane Minkin, MD, clinical professor of ob-gyn at Yale and author of a Woman's Guide to Menopause & Perimenopause
Which symptoms indicate that hormone changes are causing a low libido?
Minkin: Vaginal dryness or pain during intercourse. Before I do any fancy workups on a patient who's experiencing these problems, I prescribe a vaginal estrogen cream, which you apply directly to the labia. That solves it for many women. Just about anyone -- even breast cancer patients -- can use estrogen cream.
Now, let's say we fix the dryness or pain, but the woman still has no interest and she knows it isn't a lifestyle or a relationship issue. We'll test her hormone levels, and then we might try systemic estrogen in pill form or testosterone. Unfortunately, in the United States we don't have an FDA-approved testosterone for women, so I'll do an off-label prescription of a very small dose of the type approved for men or try a testosterone cream that can be applied to the thigh or labia. This increases blood flow to the genitals, aiding arousal. There are a few adverse side effects with testosterone -- like increased facial hair and acne -- but with a small dose, it's not a big deal. I had one patient call me years ago to tell me that she was noticing a few stray facial hairs after starting testosterone. I said, "Okay, we'll just lower the dose." I'll never forget the tone of her voice when she said, "No, no, we won't!" The effects were worth the slight downside.
With any of these treatments, I tell patients to try them for three months. If they don't work, we reevaluate.
What other age-related health issues cause libido problems?
Minkin: As we get older, we take more meds, and our partners do too. Some drugs do a very dirty job on sex drive. The classic is SSRI antidepressants, such as Prozac. Cymbalta -- a newer antidepressant, called an SNRI -- may have less of an effect, which is the case with Wellbutrin, also not an SSRI. If you really like your SSRI but don't like the sexual side effects, some docs add a prescription for a small dose of Wellbutrin to solve the problem.
Drugs for high blood pressure are notorious for decreasing erectile performance, and they can also block orgasmic response in women. Your doctor can switch your medication. Hypothyroidism, which is a huge problem for women in this age group, is subtle and is associated with decreased sexual response. Ask your doctor for a TSH [thyroid-stimulating hormone] screening test, which we now recommend for all women over 50. It can be performed in her office.
Okay, so let's say the problem isn't health-related but has to do with getting used to the idea of aging.
Minkin: What you think of yourself is crucial. As my good friend Dr. Ruth says, "The most important organ in the body for sexuality is between the ears, not between the legs." Many 40-plus women feel they're not as attractive as they once were, but if you ask me, it's bullshit. The young, immature starlets on their third trip to rehab are not so alluring, really. The interesting thing is that when we research societies where age is valued, women have fewer menopausal symptoms, like hot flashes, so there's something to be said for appreciating your age.
We so often talk about over-40 sex being problematic, but aren't some women having the best sex of their lives during this time?
Minkin: Absolutely. Menopause can be liberating, because you no longer have to worry about getting pregnant or deal with painful conditions like endometriosis and fibroids. For a lot of people, menopause turns out to be a blessing for all its sexual benefits.
