HOW TO MAINTAIN YOUR SEXUALITY AND IMPROVE A FLAGGING LIBIDO

Thousands of women have written to me over the years revealing their sexual frustrations and problems and it has been a shock to see how little help women receive with these problems. Ideally, as a woman ages she becomes more relaxed as a sexual being, realising that the most important thing about sex is that it is fun and stress-relieving. She is also more knowledgeable about her own individual needs and what it takes to give her sexual satisfaction. Maturity enables her to be more easily assertive and effective in asking to have her needs fulfilled. Many women have told me that their sexual desire increases as they age and for most of them there is more sexual interest, pleasure and capacity for orgasm. These women confirm that enjoyment of sex appears to rise continuously into the middle years and remains stable from that time on.
That would be great — but it could be wishful thinking. As a doctor I have found that many women have huge fluctuations in libido (sex drive) and enjoyment of sex especially as they are approaching the menopause.
When the level of the sex hormones of both male and female variety are low, the sex drive will suffer. This may occur for six to twelve months after childbirth and also gradually after the age of 45 to 50 years as the menopause approaches. If the levels of the sex hormones are low, there may also be a change in the personality and a woman may become disinterested and unresponsive, and shun the advances of the man she has previously loved and desired.
It is sad when these problems in older women disrupt an otherwise good relationship or marriage. This is unnecessary because early help could salvage both the woman's sexuality and the man's ego. Then, divorce rates and the number of lonely middle aged people would definitely decrease.
It is interesting for me as a doctor to find that poor libido or sex drive is a common problem in women. No one ever complains about having too much libido and indeed it seems for some the more the better!
The greatest destroyers of the libido include:
1.         Insufficient production of the male and female sex hormones. This can be aggravated by an unhealthy lifestyle and diet, and laboratory testing shows that men and women who drink and/or smoke excessively have lower levels of sex hormones in their blood. Women who smoke heavily are more prone to an early menopause which will further reduce their libido.
2.         In men the fear of poor performance or premature ejaculation causes stress and reduces libido. Thankfully, women are far less prone to this type of stress.
3.         Menopausal women are susceptible to vaginal shrinkage and dryness and so may experience pain during sexual intercourse. Furthermore, if shrinkage of the vulva and clitoris occurs, normal lubrication and orgasmic capacity become very difficult. Understandably, many menopausal and postmenopausal women in this situation avoid sexual contact.
4.         Various prescription medications may reduce libido. Take the example of Peter, a 44-year-old, aggressive business executive. Despite normal ups and downs in their sixteen years of marriage, he and his wife had never had sexual problems until Peter accepted drug treatment for ulcer pains. Despite his strong desires, he is discouraged to find that his erections no longer last. Or take the case of Christine who has started anti-depressant medication for her chronic depression. Although her moods and libido have returned to normal, she is frustrated by her inability to achieve orgasm. It is now increasingly recognised that situations such as those of Peter and Christine are common. A wide range of drugs may affect sexual function causing loss of libido, arousal difficulty, orgasmic dysfunction or reproductive impairment. The most common drugs to cause these problems are appetite suppressants, some muscle relaxants, some drugs for epilepsy, some drugs to prevent headaches, some drugs to treat high blood pressure, some sedatives and anti-depressants, some anti-ulcer drugs and some hormones, particularly anti-male hormones. Make sure you check with your doctor before you're given a new medication as you may be in for a surprise when your sexual ability and desire become reduced through the medication. There is often a suitable alternative drug which will not do this as new derivatives of older drugs which have a lesser incidence of side effects are becoming available every day.
5.         Boredom and routine may creep into a long-term relationship, especially if the male partner is unaware of the needs and changes in the sexuality of a woman as she ages. He may not realize that he will need to be gentler and take more time to stimulate his partner before entry.

WHAT TO DO FOR A POOR LIBIDO
If you find yourself in the quandary of poor libido and loss of sexual enjoyment and performance which is disrupting a valuable relationship, see your doctor for a thorough medical checkup to see if there is a physical disorder or disease that could be causing this situation. Such disorders are thyroid imbalance, high blood pressure, diabetes, hardening of the arteries, lower back problems or diseases of the nervous system, such as multiple sclerosis. If, after a thorough physical examination, your doctor cannot find any obvious physical causes to explain your problem, the next step is to have the level of the sex hormones measured in the blood. If these levels are low or borderline (at the lower limit of the normal range), you should benefit greatly from specific Hormone Replacement Therapy.
It may require a little time, patience and experimentation with different types of hormones to find the right combination to turn you on. Some combinations and types of synthetic hormones will frankly turn you off and for this reason women who have been taking the synthetic hormones found in the oral contraceptive pill for some time often experience a reduction in libido. Similarly, some menopausal and pre-menopausal women find that conventional oral HRT with oestrogen and semi-natural progesterones does not recapture their former enjoyment of sex.

GENERAL MEASURES TO HELP A POOR LIBIDO
You and your doctor have several alternatives to play with to encourage the libido and I will qualify these with my own clinical results. Firstly, the use of conventional tablet forms of HRT containing natural oestrogens and semi-natural progesterones will restore the capacity for a normal sex life in the majority of women suffering with a sex hormone deficiency during premenopausal, menopausal or post-menopausal years. In addition, for those women with a dry over-sensitive or fragile vagina that fails to lubricate adequately, the use of vaginal oestrogen creams or pessaries applied to the vagina and vaginal lips or vulva can be extremely beneficial. Many women with these problems turn to bland creams or jellies such as 'K-Y jelly', but these have only a temporary lubricating action.
Conversely, hormonal creams and pessaries restore and rejuvenate the mucosal lining of the vagina and vaginal lips and improve the circulation of blood to the clitoral area, thus restoring the capacity for natural lubrication and orgasm. Some of my patients have told me that vaginal oestrogen creams or pessaries act like an aphrodisiac and make them feel very sexy.
Some menopausal women have shrinkage of the vagina, vulva and clitoris and painful scar tissue forming in the roof of the vagina which can make
it impossible for the penis to penetrate without pain. These problems can be overcome by regularly massaging the inside of the vaginal walls with oestrogen cream and gently stretching apart the vaginal walls with your fingers. This can be done gradually more and more each day and there is no need to stretch excessively and cause pain. In some women, particularly those who have undergone a premature menopause, shrinkage of the vulva and clitoris can be extreme and in these cases, both an oestrogen cream and a male hormone cream can be massaged gently into the vulva and clitoris two or three times daily. The chemist can make up the male hormone cream specially from ampoules of pure testosterone which are mixed in a 2 to 5% concentration in oily base. These ampoules are called Primoteston.
In some women the vulva becomes dry and extremely itchy and the lips of the vagina become pale, shrunken and chronically inflamed. In women suffering with such a dry, itchy and inflamed vulva, naturopathic supplements can reduce the discomfort and inflammation. The appropriate supplements to take are evening primrose oil capsules, 3000mg daily and the Naudicelle brand of evening primrose oil is particularly beneficial because of its high concentration of gamma linoleic acid (GLA). Natural Vitamin E 500 international units daily should also be taken along with a high quality antioxidant tablet in a dose of one tablet two times daily. Added benefit will be obtained by taking Vitamin С 6000 mg daily either in a powdered or tablet form.
If recurrent infections of the vagina or vulva complicate the problem, bathing the area in tea tree oil shampoo instead of soap is useful. If infection with Candida is present, the tea tree oil shampoo will act as a deterrent to the growth of the Candida fungus and added effect may be obtained by the application of nystatin cream to the vagina on retiring at night.
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