While women are usually blamed when sex fades in a relationship, it is the health of the partner that sometimes determines whether she enjoys sex after menopause or not, reveals a new study.
Many past studies have looked into the physiological reasons why women stop wanting, having and enjoying sex later in life. But is menopause largely to blame?
The new study involving 4,418 participants, more than two-thirds of them with intimate partners, finds that the reasons why, for many women, sex in later years is not as satisfying as it used to be are more complex than just hormonal changes.
One in four, or about 27 percent, of the post-menopausal women who had an intimate partner but were not having sex blamed the situation on their partner’s poor health, shows the study recently published in the Journal of the North American Menopause Society Menopause. The rate was double that of women who ascribed their waning sex life to problems associated with menopause. Two-thirds, or 2,883 participants, had intimate partners.
Some women reported that they or their partner were embarrassed and reluctant to discuss sexual issues with a healthcare provider. “My husband is taking tablets which may or may not make him impotent. At 75 he thinks it's not necessary to discuss that with his doctor. I disagree,” said a sexually inactive 68-year-old.
Overall, two-thirds (65 percent) of study participants with intimate partners were not having sex. Sometimes multiple medical conditions and complex care needs were reported. “My husband has Parkinson’s disease and TB of the vertebrae. At the age of 77, he also has dementia and is in hospital at this present time due to a fall,” said a 73-year-old woman who is not having sex.
Sexual dysfunction of the intimate partner was mentioned by about 14 percent of participants with spouses. This predominantly involved erectile dysfunction (ED) which had limiting effects on women’s sexual satisfaction. ED is often related to chronic medical conditions such as heart disease, obesity or diabetes.
In some cases, psychological factors interfered with sexual feelings and resulted in ED. “My husband has a very stressful job and when we make love he has a problem with keeping his erection long enough to satisfy us both,” said a 57-year-old participant.
Sexual problems were sometimes linked to medication use for women and their partners (seven percent). Most responses referred to drug-related loss of libido, ED or the inability to have penetrative sex. Few women mentioned that these problems had been restricting their sex life for many years while others had accepted the situation. “My husband is on medication which prevents him from getting an erection. However, we are both quite happy with a kiss and cuddle after 42 years of marriage,” said a 64-year-old respondent.
Embarrassed and reluctant
Many of these physical health-related problems had significant effects on sexual function. Some women reported that they or their partner were embarrassed and reluctant to discuss sexual issues with a healthcare provider. “My husband is taking tablets which may or may not make him impotent. At 75 he thinks it's not necessary to discuss that with his doctor. I disagree,” said a sexually inactive 68-year-old.
One in six women with partners, or 510, also reported that their own health-related problems impacted sexual activity and satisfaction.
Still, about 13 percent of the problems faced by the women were associated with menopause, including vaginal dryness, painful intercourse, reduced libido and arousal, and difficulty achieving orgasm. “Since the menopause, an extremely important part of my life, intercourse, is ruined. This is because of vaginal dryness and spasm, reduction in physical desire (but not mental), and change and huge reduction in gaining orgasm and in intensity of orgasm,” said a woman age 55 who is not having sex.
Many women also mentioned multiple issues as disruptive to their sex life. The study that involved respondents with a median age of 64 years found that seeking help and treatment for sexual problems was low. Just six percent of the women with intimate partners, predominantly sexually active ones, sought help and treatment. A primary care physician was the main source of support for participants who disclosed this information.
Few women described how treatment for menopausal symptoms had a positive influence on their general well-being: “The menopause and tiredness has been affecting me badly. I began hormone therapy this month and feel more positive that am doing something about it with great support from my doctor, friends and family,” said a sexually active 50-year-old.
Other women had developed their own coping strategies, altered their views towards sex within a relationship, and emphasised the importance of love, companionship, and commitment. Some adapted their sexual behaviour or found alternatives for sexual intercourse, which enabled them to continue having an intimate relationship: “My husband has heart problems so we don’t have sex a lot. We satisfy each other in other ways which is fine with me,” said a 62-year- old.
Several themes related to mental well-being affecting either of the couple were also cited, including mental and physical fatigue, and psychological concerns. Mental health issues, including depression, anxiety, bereavement, alcohol addiction or stress affected six percent of women and their partners equally.
Stress relating to work and the demands of caring for older relatives was also mentioned in this survey. “Caring for older parents at the present, lack of energy and worrying about them causes a reduction in sexual activity,” said an active 53-year-old woman.
Other psychological concerns mentioned by very few women included traumatic experiences, phobias, low self-esteem, or problems related to physical appearance, body image, or self-perception. “I had breast cancer and feel less feminine with the scars and deformity’, said a sexually inactive woman age 57.
Still, the main reason cited for absence of sexual activity among the postmenopausal women was lack of a partner, mainly due to widowhood and divorce (a third).
Several women indicated that they were satisfied living without a partner and they could be described as happy singles: “I have been on my own for 18 years, therefore, without sex. I don’t miss sex, I don’t think about it, and I am quite content leading a single life,” said a woman age 51.
Others, however, found it much harder to cope with living a single life, or mentioned that they had lost the confidence to start (new) relationships: “I have found it very difficult to meet a man since I have been divorced. This does make me sad as I would love a good friend,” said a 64-year-old woman.
A few comments referred exclusively to positive sexual experiences or age-related changes. Some of these women noted reduced frequency or loss of spontaneity, but highlighted that other aspects, such as non-penetrative sex, had become more important. Others highlighted their satisfaction with their sex life and relationship: “We are in our 60s so quality rather than quantity matters. I have a problem with vaginal dryness so we have to be very imaginative! I am married to a lovely man,” said a 59-year-old.
Few reported that their sexual activity was as good as it had ever been in their relationship, or mentioned that a new partner positively influenced their sexual well-being: “As I have a new partner since one year, I find my sexual life has never been better and it is certainly very frequent. It is very much the reason for my happiness, contentment and wellbeing,” said a 59-year-old.
Lack of interest
One in six (16 percent) women and seven percent of their men lacked interest in sex. Sometimes couples made a mutual decision to stop activities but not always: “I would still welcome an active sex-life, but my partner who is 57 years old does not seem to have the same sex drive as he did before his fifties. So sex only happens once every 3-4 months,” says a 55-year-old.
Sometimes, women indicated that sex was central to a committed relationship. Some perceived sex as an act toward benefiting their spouse rather than themselves engaging in activity despite pain or lack of pleasure: “I indulge in sexual activity to please my husband. I do not feel any sexual satisfaction from the activity. I do however enjoy the closeness and I am pleased that my husband enjoys the activity,” said a 67-year-old.
The study is a qualitative analysis of the free-text comments from a larger survey of more than 24,300 women taking part in an ovarian cancer screening study in the United Kingdom. The women, aged 50 to 75, answered multiple-choice health questionnaires about their sex lives at the start of the study. But almost 4,500 of them also left written comments, giving researchers from the University of Sussex in Brighton and University College London, both in the UK, and the University of New South Wales in Sydney, Australia, a unique opportunity to glean new insights about women’s sex lives.