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

Last Editorial Review: 10/23/2003

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).

However, The effects of menopausal status (hormones) and age were not as significant a predictor as feelings toward sexual partner (P=0.003)! Thus we can see that even those earlier studies that show that factors like partner's age/health, level of past sexual functioning, stressors, etc... had some effect were right, too. 

Let's spend our last time together talking about the role of testosterone in enhancing sexual drive, OK?

Mature_Years_Mod sounds great

Speaker_Harrison-Hohner Women have several sources of testosterone and testosterone precursors. With aging levels can fall; within certain individuals they may have higher or lower levels to begin with. The most potent testosterone in our bodies is called "free testosterone"; it is the one that can stimulate connections to libido. If one wanted to "get their hormones checked" a free testosterone-although more expensive than a total testosterone- gives a truer picture. Studies have shown that testosterone supplementation has the best effect in women who truly have lower levels.

There are a variety of recommendations about dosing and type of testosterone. Natural testosterone (NT) like our bodies make is less potent than synthetic methyl testosterone (MT) by about 50%. While most of us tend to prefer the natural route.. NT can be aromatized (broken down) by the body into estrogen--so you may not get the full libido effect (if that's what you want!). MT aromatizes less, but if taken orally can have a stronger effect (negative) on the liver and your cholesterol profile; thus, there are trade offs.

The dose issue is controversial. The lowest dose of MT that one hears recommended is 0.25 mg. The combined estrogen+MT product called Estratest has two strengths-one has 1.25 of MT and the other has 2.5 of MT. You can also get MT as a 10mg pill and try to cut it into 1/4ths if you are already using estrogen in a patch but it is difficult as the pills are tiny....One can see that the suggest dose range is wide. One researcher in Canada used very high doses to get very pronounced effects, but most of the time this is not advisable as women can develop negative side effects such as acne, increased hair growth in undesired places....a cholesterol profile more like a man (bad news), and some women get angry /irritable...

In summary, in my clinical experience, even in women who really want testosterone to work for them not everyone gets the desired effect...That is because desire is such a complex thing, even more complex than hormones like androgens/estrogens/sex hormone binding globulin!!!!  If you in the audience are considering using hormones for libido I would suggest: chose a provider who works with these issues, get a initial free testosterone, get a follow up lipid and or liver panel. Thanks to you are and Happy Loving Day.

Mature_Years_Mod  Unfortunately that's all the time we have. I would like to thank you Ms. Harrison-Hohner once again for being our guest speaker on WebMD Live. You have been wonderful and informative. Thanks to everyone who joined us. Please check the schedule listing for other Health In Your Mature Years' shows that are coming up. Have a Wonderful Day and Take care!

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