Premature menopause (before age 40) can adversely affect a young woman’s sexual identity, sexual function, and sexual relationship. Therefore recognising premature menopause early and planning interventions is essential for positive outcomes.
You are young and considered to be in your sexual prime. So relationships are often new and sex has never been a problem in the past until now. It can be really distressing to have hot flushes, mood swings and night sweats at such a young age. Another common symptom of premature menopause (PM) is vaginal atrophy –dry thinning walls of the vagina which makes sex uncomfortable. This can develop into a vicious cycle where past experiences of painful sex cause anticipatory fear of more pain. The fear then creates stress, tension and reduces your libido and arousal. Because the sex is often painful, trying to explain to your partner what is happening with your body can be frustrating and embarrassing.
PM is a major turning point in a woman’s life: the younger the woman, the higher the risk of significant health and psychosexual impact. Alessandra Graziottin, the author of the study investigated the influence PM can have on a woman’s overall sexual development. Graziottin identified three areas a woman’s developing sexuality is impacted; sexual identity, sexual function, and sexual relationships. This is a brief summary of her key findings.
Sexual Identity – (I’m sexy and I know it)
Graziottin defines sexual identity as how you see or define yourself as a sexual being. Another way to think of it is as your sexual self-image. The study argues a woman’s sexual self-image is negatively impacted by PM; the younger the woman the more severe the impact can be on sexual identity. Graziottin identified several aspects of sexual self-image that are severely impacted. These include:
- Producing eggs
- The ability of the organs to convey the eggs to the point of fertilization
- Behavioural – the urge to behave sexually
- Skin and hair texture
- Increased wrinkles
- Increased dryness of skin and other tissue
- Change of body shape, muscle tone and strength
Reduced sense of femininity and sensuality
- Loss of cycling periods means loss of biological clock and isolation from fertile female friends.
- Loss of sexual desire
Sexual Function – (I’m turned on by you)
Sexual function is the ability to become aroused and perform sexual acts without pain or discomfort, and with desire and enjoyment. PM influences sexual function by changing the balance of hormones in the body. The decline of estrogen can lead to:
- Disruption in the neurobiology of sexual drive and arousal
- Lack of energy, decreased muscle strength and tone, and even reduced assertiveness
- Genital arousal disorder
- Vaginal dryness and genital pain during intercourse
- Sexual avoidance, or interest/desire disorders
- Orgasmic disorder
Treatment of the above conditions can either be medical, which generally consists of hormone replacement, and/or psychosexual consisting of behavioural educational treatment.
Sexual Relationships (You and me)
The definition is relatively straightforward; PM can affect relationships that were present before menopause and/or forming new sexual relationships after premature menopause. Relationships are affected by the following:
- The partner’s reaction to the associated infertility
- The partner’s personal sexual health
- Loss of motivation to initiate or accept sex due to a feeling of ‘it’s worthless now’
- The quality of intimacy and of the relationship before the onset of menopause
- Premature menopause can potentially lead to the partner developing sexual dysfunction; vaginal dryness makes penetration uncomfortable, which leads to erectile dysfunction or delay in ejaculation.
♥Sexual dysfunction is a common symptom complaint for PM
♥Psychological distress associated with sexual dysfunction is higher the younger you are, therefore at greater risk for sexual disorders.
♥Determining whether you will have sexual issues consists of multiple factors such as: age and response to diagnosis, effects of declining hormones, severity of symptoms, and loss of fertility and its meaning to both you and your partner
♥Sexual dysfunctions associated with PM need a multidisciplinary approach
♥Professional support available includes: individual behavioural therapy, psychotherapy to cope with the many losses and diagnosis, couple’s therapy to address nonsexual couple issues, such as conflicts, poor erotic skills or communication inadequacies
♥Various treatments exist such as hormonal: HRT variations, vaginal estrogens creams to help treat vaginal dryness – a leading complaint of genital arousal disorders
♥Non hormonal treatments include reflexive pelvic muscle tightening (Kegels), self-massage and stretching, using vaginal dilators or physiotherapy exercises
♥More studies are needed to assess long-term safety of hormone therapy on PM
Graziottin, A. (2007). Effect of premature menopause on sexuality. Women’s Health, 3(4):455-474.