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Menopause can lead to symptoms that can impact sexual satisfaction, including vaginal dryness and decreased libido.
Menopause can also cause the walls of the vagina to become thin and dry, leading to painful sexual intercourse, which can reduce women’s interest in sex. Vaginal dryness can be improved in several ways, including the use of vaginal lubricants and moisturizers, which are widely available and do not require a prescription. Women experiencing these symptoms should recognize that while these lubricants (e.g. K-Y, Astroglide, and others) can help make sex less uncomfortable, vaginal moisturizers (e.g. K-Y Liquibeads, Replens, Hyalo GYN) are designed to be used on a regular basis (not related to sexual activity). Systemic hormone replacement therapy (e.g. oral tablets or skin patches) can also improve vaginal dryness. Some doctors prescribe low-dose local vaginal estrogen medications such as Estring, Vagifem tablets, or Estrace or Premarin cream. Research suggests that only a small amount of estrogen applied vaginally is absorbed by the rest of the body; it may be safe for breast cancer survivors who cannot take systemic hormones.
“Libido” refers to an individual’s level of sexual desire. Many women experience decreased libido as a side effect of menopause. Hormones can improve libido in women who are surgically menopausal. Some physicians recommend the addition of testosterone replacement for women who have loss of libido with menopause that isn't alleviated by estrogen and progesterone alone. Conflicting data, however, raises questions about the safety of testosterone, and whether it may increase the risk for breast cancer. In addition, testosterone is not approved by the FDA for use by women.
Some small studies looking at the effects of the antidepressant bupropion (Wellbutrin) on libido suggest that the drug may improve sexual arousal, overall sexual satisfaction, and satisfaction with intensity of orgasm. Larger studies are needed to validate these findings.