There are natural ways to enhance desire

For many perimenopausal or menopausal women, while the desire for sex remains, its form can shape-shift.

“The pyrotechnics of youth may be gone, but I have learned that there’s no aphrodisiac like long love, like the feeling of knowing and being known, of belonging to a beloved’s body as fully as you belong to your own,” wrote Margaret Renkl in the New York Times last year.

Life goes on.Credit:AFR

And, of course, mercurial as desire may be, life and even sex do go on after menopause, as Candace Bushnell reflects in her new novel,  Is There Still Sex in the City?

“It might not be that acceptable in society, this idea of women over 50 wanting to have sex and feeling like they should be able to have sex, but women definitely seem interested,” Bushnell, who is  60,  said.

Still, nearly a third of women admit to experiencing low sexual desire and feel distressed at the onset of menopause, which generally occurs around the age of 51.

A new review, published in The Lancet, found that women who took the hormone supplement testosterone enjoyed significantly increased sex drive, sexual satisfaction and overall sense of wellbeing.

Levels of testosterone – which is primarily a male sex hormone, but is also associated with mood, metabolic and cognitive functions as well as libido – decline naturally with age.

Previous research has found testosterone therapy may help but no approved testosterone product exists for women and instead they are treated using higher concentrations formulated for men.

“And there are no internationally-agreed guidelines for testosterone use by women,” explained the study’s lead author, Professor Susan Davis from Monash University.

Davis, who added that the “beneficial effects” of testosterone extended beyond increased sex drive to improved self-image and wellbeing, said guidelines and further study are “urgently” needed as there are side effects.

Associate Professor Gino Pecoraro, an obstetrician and gynaecologist from the University of Queensland, agrees.

“There are still so many questions,” Pecoraro says. These include understanding how testosterone works in the body? What drugs it interacts with? What the right dose is and how long it should be given for?

“Using testosterone in women is controversial,” adds Dr Sonia Davison, an endocrinologist at the Jean Hailes Foundation for Women's Health.

“The common side effects are reversible: excess body or facial hair growth, scalp hair loss, acne or oily skin. The irreversible side effects include enlargement of the clitoris and voice deepening, this is why it is essential that women are advised by an expert in this area, and with close monitoring of testosterone levels and safety parameters.”

While testosterone supplementation remains contentious, there may be a way to side-step the adverse effects: boost levels naturally.

A study from earlier this year, by researchers from UNSW, found that twenty minutes of interval training (8 seconds of sprinting followed by 12 seconds of light pedalling) on an exercise bike three times a week reversed some of the negative effects of menopause and significantly improved lean muscle mass.

There is “some evidence” that increased muscle mass, through exercise, gives the “good effects” of testosterone, Pecoraro adds.

Getting out in the sun and exercising at the same time is even better he says.

“It improves mood and that will improve libido … And nothing bad will happen to you, unless you get sunburnt.”

Along with strength-building exercises, “the best way to boost testosterone naturally” is to consume enough protein, says accredited practising dietitian, Melanie McGrice.

“After menopause, women’s dairy requirements dramatically increase from 2.5 serves per day to four serves per day. Meat serves decrease from 2.5 serves per day to two. Dairy is important for increased calcium requirements and maintaining muscle mass (and thus testosterone levels),” explains McGrice, who adds: “Adequate vitamin D is also essential, so try to get outdoors for 30 minutes each day. This also helps to reduce stress which can also have an impact on testosterone levels.”

But while testosterone can help, be it naturally or through supplementation, it is only part of the picture.

“Adding testosterone may not actually be the solution,” advises Davison, who suggests talking to a women's health specialist, “and there may be another strategy that could be effective.”

Pecoraro points out that many hormonal changes occur during menopause and there is “a delicate interplay” at work. Besides, he adds, “libido is notoriously complex”.

Another new study found there were many reasons why 65 per cent of the menopausal participants had a partner but only 22.5 per cent were sexually active.

While low libido was one factor, relationship problems, lack of time together, exhaustion from caring for elderly parents or children, mental and physical ill health were among the many other factors.

“My husband had a stroke which left him paralysed. Sexual relations are too difficult. I remain with him as a caregiver and companion,” said one 52-year-old participant.

Added another 62-year-old: “My husband has had a heart attack – his medication leaves side effects, which makes sex very difficult, which has saddened us.”

So, apart from cases in which there are medical reasons causing serious sexual difficulties, testosterone (naturally generated or administered) may assist women who are experiencing a loss of desire or discomfort during sex. What it cannot replicate is the joy of intimacy. For that, it takes two.

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