Dear Dr. Anderson:   I am 60 years old and have had a lack of interest in sexual relations for the past 5 years.  My husband, who is the same age, doesn't share my lack of interest.  I have never taken any hormonal medicines because I feel they are unsafe and I cringe every time I see male medications advertised because it goes against what I believe about sexuality. The man can always "be ready" in spite of what his wife might feel.  I feel that our bodies were planned by God to be this way and we shouldn't try to do things that make us think we are in our 20s again.  My question is, am I right in just wanting to stop this part of our marriage, or am I obligated to just go along with things until my husband loses interest also?  He knows my feelings, but struggles with them.  There is an underlying tension because he doesn't want to talk about it.   Thank you for your help.  I feel this is a sensitive issue that most women don't want to inquire about it.

Dr. Anderson: 

This is an excellent question.  You are correct to assume that many women are hesitant to discuss their lack of desire for sexual relations. That said this is a question my patients frequently ask me.

The natural order of life is for sexual desire to decline beginning in the premenopausal years.  One can’t argue with biology.  You are also correct that since the Women’s Health Initiative in 2002, the literature has supported limiting exposure of menopausal women to hormone replacement for a variety of reasons, not the least of which is an increase in the risk of breast cancer, heart attacks, strokes, and DVT’s.  The good news is that hormone replacement was never a panacea to correct lack of sexual desire anyway.  The two most important influences on sexual relations are the strength of the relationship and the physical condition of each spouse.  Communication is essential.  Have a physical to identify any underlying problems such as thyroid or adrenal issues.

One of the chief reasons sexual desire decreases is that women experience painful relations due to thinned vaginal tissues.  This condition is known as vaginal atrophy.  Avoidance of pain is natural, and this example is no exception.   Over the counter lubricants are sufficient to help some women.  Others benefit from prescription vaginal estriol or other estrogen formulations which have been designed solely for local absorption, thus limiting the health risks associated with systemic estrogen exposure.  So if pain is the issue, consider one of these treatments.

Once pain has been addressed, concentrate on the relationship itself.  This is a time to grow and discover new dimensions.  With the decrease in childbearing and childrearing responsibilities comes a whole new set of opportunities.  Bring energy to the relationship.  Explore together and individually what this new phase of life has to offer:   spiritually, emotionally, and professionally.  This change in focus also provides great opportunities to grow in sexual intimacy and enjoyment.  The most important sexual organ is the brain.  Commit yourself totally to each other.  Remember, there is a huge incentive to come to a mutually agreeable solution regarding any sexual dilemma.  Ultimately, whatever frequency and duration a couple decides, is right for them.  There is no standard answer. You are laying the groundwork for the direction your relationship will take for the rest of your life.   Act accordingly.

Viagra and the enormous publicity surrounding it speak volumes about the values of our culture.  It is about performance and power rather than love.  Sometimes, it is good to be counter-cultural.  Viagra is an external force that changes the equilibrium of a particular sexual relationship.  The effects are only good if both spouses feel they are good.  There is no question that this drug can be a boon to the quality of life for many couples in which the man suffers from erectile dysfunction due to health conditions or the medications used to treat them.  But enhanced sexual performance through medical manipulation cannot fix a broken relationship.  Adding Viagra can mean that the woman becomes an object to be used rather than a spouse to be loved and cherished.  Expressing love, not selfish gratification, should be the objective for having relations.  Many women prefer activities such as cuddling, back rubs, and having their spouse truly present, rather than the sexual act itself.   Women want to be loved, not used.   If Viagra helps that to happen, then it is good.  Otherwise it is not.  A pill cannot replace a loving relationship, but it can challenge one.