Sexual Responses for Women over 55, Physiological Changes and Available Options with Jane Harrison-Hohner, R.N., R.N.P.

By Jane Harrison-Hohner
WebMD Live Events Transcript

A Valentine's Day Program for Women Only -- Covering Women Issues including Sexual Response, physiological changes and available treatments.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Mature_Years_Mod Welcome to the Health in Your Mature Years Auditorium. Today's guest speaker is Jane Harrison-Hohner. Today's Valentine's Day Program is for Women Only---sexual response in the older woman. Welcome Ms. Harrison-Hohner, thanks for joining us today. Would you please start off today's discussion by telling everyone a little bit about your area of expertise?

Speaker_Harrison-Hohner Happy Valentines Day to Mature Lovers everywhere! While there have been many women with a legendary capacity for physical lovemaking. Mae West and Catherine the Great who passed away at age 67 after enjoying the company of her 22 year old companion!); between 40 and 60% of menopausal women report decreased sexual activity because of decreased desire.

I am a Woman' Heath Care Nurse Practitioner and faculty at the Oregon Health Science University. I have a clinical practice where I see mid-life women, I do research in the areas of PMS, postpartum depression and have a special focus on menopausal concerns.... I am fortunate to get to direct my attention on the interface of hormones and mood. Thus today's topic --sexual concerns in the mature woman fits into this niche.

Let's begin with a quick review, based upon the landmark work of Masters and Johnson about the physical/sexual changes that happen with aging. Fortunately, it has been shown that all four stages of the sexual response cycle (excitement, plateau, orgasm, and resolution.... remain present although may be somewhat decreased as we age... In the excitement phase the breasts may be less engorged and less sensitive...Blood flow goes to the clitoris as before but the flattening and separation of the labia--which normally happens-- may be diminished or lost.

Later studies by Sorrell at Yale demonstrated changes in blood flow to the vulva depending upon a woman's hormonal status....During the excitement phase there is normally increased vaginal lubrication, and increases in muscle tension, heart rate/blood pressure...When orgasm occurs there is a release of tension and muscular contractions including the uterine contractions.

With aging there is a decrease in the number of contractions and they may be of shorter duration...Often I hear from women in the privacy of the exam room that they still can be orgasmic but it just doesn't "rock the world" like it used to do. Some women even experience the uterine contractions as painful... These are the physical responses, identified in the laboratory setting. The hormonal changes that may be associated with the physical changes include both estrogen and testosterone, and likely others. It would seem that a good sexual experience is comprised of several variables. Most women are aware that estrogen can increase the thickness and ability to stretch of the vaginal walls themselves. Estrogen can increase the amount of vaginal secretions, and keep the vaginal at a more healthy (acidic) pH. Estrogen, acting as a vasodilator like it does in the arteries of the heart, can allow more blood flow to the genital area. This increase in blood flow has been documented by dopler flow studies of hypo-estrogen women before and after estrogen treatment (what a study that must have been!).

We can surmise that increased blood flow is good for sexual response. While some researchers have pointed to changes in libido-or the desire to be sexual- in women who have started taking estrogen.... the data is mixed. It is more likely that estrogen helps with the physical side of sex. Similarly, Viagra.... which is a vasodilator, enhance blood flow but do not increase desire. By contrast, testosterone probably has a greater role in stimulating libido. Once again, the research data is very mixed; this is because sexual functioning is such a complex phenomena.

I would also like to discuss if the changes in sexual capacity are menopausal or age related. This is an area of confusion because advancing age and menopausal/estrogen status are closely linked. One research group in Scandinavia attempted to untangle this question. In a large group of Swedish women (800), followed over time, women were divided by both decade of age and menopausal status. As we all know not everyone is just turning menopause at 50! The initial analysis showed decreased sexual function with increasing age, but when they adjusted for the woman's menopausal status.. it appeared that it was not age but being around menopause that was the determining factor. This study was done in 1977 and they did not do blood testing. .. Women were asked about their last periods, and as many of you know that isn't always the best way to determine if someone is truly menopausal... More recently, the Women's Midlife Health Project in Australia has been examining this issue. .. That group of researchers has been doing blood test such as estradiol, FSH, and inhibin. Those hormones-at menopausal levels- showed statistically significant effects when analyzed with libido measures (P=0.02).