According to the Caregiving in the U.S. 2020 report published by the National Alliance for Caregiving (NAC) and AARP, 61 percent of family caregivers are women ages 50 and older. Most caregivers are caring for an aging parent (42 percent), parent-in-law (8 percent) or spouse/partner (12 percent).
For many women, caregiving takes a heavy toll on their romantic relationships. Priorities can quickly become overwhelming and leave a partner or spouse feeling neglected or forgotten. Physiological changes due to menopause can complicate things even further.
If a caregiver is fortunate enough to get some alone time with their partner, any number of things can get in the way of enjoying this romantic respite. Brooke Faught, DNP, WHNP-BC, NCMP, FAANP, IF, clinical director of the Women’s Institute for Sexual Health (WISH) in Nashville, TN, shares her expertise on the various sexual problems that women commonly experience after age 50 and how caregiving can negatively impact intimacy.
Common Sexual Health Concerns for Menopausal Women
As women age, reproductive hormone levels in the body naturally decline, eventually resulting in menopause (the end of menstrual cycles). According to Mayo Clinic, the average age of menopause in the U.S. is 51, but each woman’s experience is unique. “Sudden menopause” is also possible for women who have had their ovaries surgically removed.
Most are familiar with the bothersome symptoms associated with menopause like hot flashes, night sweats, mood changes, difficulty concentrating and weight gain. These tend to fade over time, but new health concerns emerge in postmenopause that may directly affect a woman’s sexual health and quality of life. One of the most prevalent conditions Faught sees in women over 50 is moderate-to-severe dyspareunia, which is painful intercourse due to vulvar and vaginal atrophy.
“After menopause, estrogen declines, and that leads to a physiologic change in vaginal skin cells,” she explains. “Women can experience this as painful intercourse and even as chronic vulvar itching, burning, stinging, tearing, bleeding—just really unpleasant symptoms.”
Since it was first popularized in the 1960s, hormone replacement therapy (HRT) has been the go-to treatment for symptoms of menopause. The use of estrogen and other sex hormones is very effective, but it does come with some serious health risks.
“There’s been a big uproar about using hormones in certain women, and then some women just choose not to use hormones,” Faught acknowledges. “Now we have non-hormonal options (oral, vaginal, etc.) that are available to treat these conditions. But, that means women really need to talk to their medical providers and be honest about their symptoms so they can have a comprehensive health assessment to determine what the best treatment option is going to be for them.”
Time is of the essence when it comes to seeking treatment as well. Faught emphasizes that these conditions are chronic and progressive. Without treatment, the vaginal tissue changes that lead to painful intercourse will only worsen over time.
“This is not something that you can just put on the back burner and say, ‘I’ll deal with it later.’ Every day that goes by, it’s going to get worse and worse,” she urges. “Upwards of 25 to 50 percent of women that are postmenopausal experience these conditions, so they’re definitely not alone.”
How Caregiver Stress Can Affect Intimacy
Family caregivers are typically under a great deal of pressure to balance their own lives and provide quality care and companionship for their loved ones. Although caregiver stress is unique, women who have a great deal of anxiety or tension in their lives can experience negative sexual symptoms at any age.
Faught describes sex as “a complicated cascade of events” that includes hormonal, muscular, neurological and psychological components. There are a lot of different factors that play into a rewarding sexual experience, and stress can be a serious hindrance on multiple levels.
“When we’re stressed, our muscles become tense, blood vessels constrict—there’s a variety of things that happen that can negatively impact the blood flow that is so critical for feedback between the brain and the genitals,” she explains. “That can lead to pain and decreases in arousal, desire, and even lubrication. It’s common for any age category, so it’s really important for women to be aware of this.”
Acknowledging the differences in how men and women handle stress is also helpful. Faught notes that men often use sex as an outlet and stress reliever. On the other hand, intimacy often becomes less of a priority for women who are overwhelmed with responsibilities, short on energy and pressed for time. Understandably, the desire for sexual activity (libido) declines.
“For women, sex becomes more of a chore in circumstances where they’re busy and they’re caring for other people,” Faught admits. “It’s really important for them to realize that sometimes making sex a priority is what’s necessary.”
Depression and Sex
Depression of varying degrees is prevalent among family caregivers, especially those who are experiencing burnout. Being depressed impacts every area of life, including one’s sex life, but antidepressant medications can sometimes contribute to the problem.
“It’s kind of a catch-22,” Faught laments. “Depression in and of itself can lead to sexual issues, but also the medications that we use to treat it can have sexual side effects. There’s really no clear answer—it’s an individualized approach that’s needed to help.”
In Faught’s experience, it is common for women who are under intense and/or chronic stress to feel depressed or develop true clinical depression. Of course, managing stress and treating underlying mental health issues take precedence, but when sexual matters are also a concern, she stresses that these factors are often interconnected to some degree. Providing your doctor with a complete picture of your physical and mental health and day-to-day experiences—both initially and after starting treatment—is instrumental in devising a plan of care that addresses all symptoms and minimizes bothersome side effects.
“I really strongly encourage women to seek care for depression just like they do for their physical issues,” Faught urges. “People often think that means with medication, but there are a lot of ways to treat depression.”
Abstaining from Sexual Activity
Whether you have voluntarily decided to forego sexual relations, or you have simply encountered a dry spell due to caregiving, divorce or other extenuating circumstances, Faught encourages women to try to keep the spark alive. Even those who have given up on the thought of having intimate relations may eventually find themselves wanting to become sexually active again. They may then have difficulties that they never experienced before, which can be both embarrassing and physically painful.
“If a woman is not sexually active, that can lead to a woman not wanting to be sexually active. That can lead to decreased arousal, sensation and so forth,” she advises.
Essentially, if you don’t use it, you’re likely to lose it. According to Mayo Clinic, “Regular sexual activity, with or without a partner, can help you maintain healthy vaginal tissues.” This increases blood flow and helps these tissues retain their elasticity.
A Holistic Approach to Sexual Health
Faught practices sexual medicine holistically, which means that she considers the whole person and the entirety of their current situation when devising a plan of care.
For example, if a patient is experiencing high stress levels or discord in their relationship, then counseling might be beneficial. Sometimes physical therapy for the pelvic floor can be helpful for sexual function as well as bladder and bowel control. She explains that combining appropriate complementary, alternative and conventional treatment options can improve the efficacy of a patient’s overall care plan.
“Another thing to keep in mind is some people think of lubricants and moisturizers as an alternative to seeing a doctor to improve their sexual health. On one hand, that’s fantastic, and I recommend those products (glycerin free lubricants and coconut oil) frequently. The problem is that’s really kind of putting a band aid on the issue,” stresses Faught. “If a woman just has mild symptoms, sometimes that’s all they need to alleviate some of their discomfort and enhance sensation. But, branching into the more moderate-to-severe category, it’s probably not going to be enough, and it’s certainly not going to reverse the physiologic changes that have happened with menopause.”
Being Proactive About Sexual Health
Faught recommends having candid discussions with your physician in order to effectively address any issues you may be experiencing. She also urges women to visit the International Society for the Study of Women’s Sexual Health website for more information on female sexual health issues and treatments.
“This is an international medical organization that is good for both professionals and the general public to find local resources on providers that treat sexual complaints both from medical and psychological approaches,” she says.
Regardless of your unique situation, caregiving, stress, emotional health, and menopause can all affect a woman’s sex life. Instead of making do with these factors, it is important for women to understand that they are entitled to enjoying themselves on this basic human level. A simple discussion with a physician can help women decide what approaches are the best fit for improving their sexual health.
Sources: Caregiving in the U.S. 2020 (https://www.caregiving.org/wp-content/uploads/2020/05/Full-Report-Caregiving-in-the-United-States-2020.pdf); Menopause (https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397); The Wild History of Women’s Hormone Therapy (https://www.everydayhealth.com/womens-health/hormones/history-hormone-therapy/); Vaginal Atrophy (https://www.mayoclinic.org/diseases-conditions/vaginal-atrophy/symptoms-causes/syc-20352288)