Be aware of changes in your sex hor­mones

Irish Examiner - Feelgood - - Health - Send your queries to suzigod­son@mac.com. Sex ad­vice with Suzi God­son

“Un­sta­ble lev­els of oe­stro­gen, pro­ges­terone and testos­terone can play havoc with ev­ery­thing from your men­strual cy­cle to your waist­line and your li­bido

I’m 44, have three chil­dren, and have al­ways had a good and reg­u­lar sex life. But about 18 months ago, I stopped be­ing able to have an or­gasm. Noth­ing has changed psy­cho­log­i­cally or phys­i­cally — my gy­nae­col­o­gist says there is noth­ing wrong and that I’m def­i­nitely not hav­ing an early menopause. I’m at a loss. >> You say that noth­ing has changed psy­cho­log­i­cally or phys­i­cally, but I find this hard to be­lieve. You don’t go from hav­ing reg­u­lar or­gasms to hav­ing no or­gasms with­out some­thing chang­ing. The most likely ex­pla­na­tion is a change in your hor­mone lev­els, and you are not too young to be per­i­menopausal. The av­er­age age for the on­set of menopause is 51, but the tran­si­tion can take up to eight years and in that pe­riod, un­sta­ble lev­els of the three main sex hor­mones — oe­stro­gen, pro­ges­terone and testos­terone — can play havoc with ev­ery­thing from your men­strual cy­cle to your waist­line and your li­bido.

The sex hor­mones serve dif­fer­ent func­tions, but col­lec­tively they are the key to sex­ual health, de­sire and sat­is­fac­tion. Oe­stro­gen is fun- da­men­tal to nor­mal sex­ual re­sponse and in­suf­fi­cient lev­els can make the walls of the vagina less elas­tic, while di­min­ished blood flow to the gen­i­tal area can mean that it takes longer to be­come fully aroused, and that makes it more dif­fi­cult for a woman to achieve or­gasm. Testos­terone also plays an im­por­tant role in fe­male sex­ual de­sire and sen­si­tiv­ity. The cli­toris, in par­tic­u­lar, is com­posed of soft tis­sue that fills with blood dur­ing sex­ual arousal. Any fall in oe­stro­gen and testos­terone can lead to a de­crease in the size, func­tion and sen­si­tiv­ity of the cli­toris, a con­di­tion known as cli­toral at­ro­phy.

You don’t say how sex­u­ally ac­tive you are now, but the “use it or lose it” prin­ci­ple def­i­nitely ap­plies. Even if it doesn’t lead to or­gasm, con­tin­u­ing to have (well­lu­bri­cated) sex will en­cour­age blood flow to your gen­i­tals and help to keep the tis­sue healthy.

Kegel ex­er­cises are also a good idea be­cause they strengthen and pro­tect the pelvic floor.

If you don’t have a vi­bra­tor, a good one to start with is the Wo­man­izer cli­toral stim­u­la­tor (€199.95 from love­honey.eu) which, while quite ex­pen­sive, is sub­tle yet ef­fec­tive.

You should also con­sider that there is a wealth of re­search to sup­port the fact that over­all phys­i­cal health is an im­por­tant in­di­ca­tor of good sex­ual func­tion in midlife. Drink­ing too much, work­ing too hard, or hav­ing an un­der­ly­ing ill­ness can all cause prob­lems with arousal and or­gasm. Stud­ies also show that weight gain, in par­tic­u­lar, can trig­ger hor­monal changes that neg­a­tively af­fect sex­ual re­sponse. In­creas­ing your cal­cium and vi­ta­min D in­take is also ad­vis­able, to pro­tect your bones and your heart and make sure that over­all you are in good health.

Fi­nally, although we think about the tran­si­tion to menopause as a time when hor­mone lev­els drop, the changes are not lin­ear, and be­fore menopause, lev­els of oe­stro­gen ac­tu­ally in­crease and be­come er­ratic, be­fore they even­tu­ally set­tle into the low, sta­ble lev­els of menopause.

Blood tests to es­tab­lish whether a woman is ap­proach­ing menopause will check the level of oe­stro­gen and FSH, the hor­mone that helps to con­trol the men­strual cy­cle and the pro­duc­tion of eggs by the ovaries. How­ever, be­cause oe­stro­gen pro­duc­tion doesn’t fall at a steady rate and FSH lev­els can jump around, a sin­gle test pro­vides only a snapshot of what is hap­pen­ing on that day, at that time. Given the vari­abil­ity of fe­male hor­mone lev­els, blood re­sults are of­ten mis­lead­ing, so don’t be fobbed off; it is your gy­nae­col­o­gist’s duty to help you to find out for sure why you have lost the ca­pac­ity to achieve or­gasm.

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