According to the AgingCare.com 2015 State of Caregiving Report, an overwhelming majority of caregivers are females over the age of 50. Ninety-one percent of adult child caregivers are daughters, and wives constitute 76 percent of spousal caregivers. The typical adult child caregiver is between 50 and 70 years old, while spousal caregivers tend to be slightly older—between 60 and 80 years old.

For many women, caregiving takes a 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 be able to have some alone time with their partner, a number of different issues can get in the way of enjoying this romantic respite. Clinical Director of the Women’s Institute for Sexual Health (WISH) in Nashville, TN, Brooke Faught, RNC, MSN, APN, shares her expertise on the various problems that women commonly experience after age 50 and how caregiving may complicate things further:

Post-Menopausal Changes

Q: What are some of the most common sexual health issues for women over 50 years of age?

A: “Probably one of the most prevalent conditions that I see 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. Women can experience this as painful intercourse and even as chronic vulvar itching, burning, stinging, tearing, bleeding—just really unpleasant symptoms.”

Q: What are some of the treatments for these issues that are so common for this age group?

A: “The wonderful thing is, in the past—specifically if we’re talking about menopausal changes leading to dyspareunia and painful intercourse—we’ve thought primarily about hormone replacement. But there’s been a big uproar about using hormones in certain women, and then some women just choose not to use hormones. Now we have non-hormonal options that are available to treat these conditions. What that means is women really need to open up and talk to their medical provider and be honest about their symptoms so that they can have a comprehensive health assessment to determine what the best treatment option is going to be for them. There are multiple different options available—oral, vaginal, et cetera.

“One thing to keep in mind is that these conditions are chronic, they are progressive, and without treatment, unfortunately, the vaginal tissue changes that lead to painful intercourse are only going to worsen over time. It’s 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. Upwards of 25 to 50 percent of women that are post-menopausal experience these conditions, so they’re definitely not alone.

Caregiver Stress

Family caregivers are typically under a great deal of pressure to balance their own lives and provide quality care and companionship for a loved one. Although caregiver stress is unique, women who are experiencing 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 include 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 inhibiting element on multiple levels.

Q: How does stress—especially from caregiving—play into this dysfunction. Does it make it worse, I would assume?

A: “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. So, that can lead to pain, that can lead to decreased arousal, desire, and even lubrication. I see this, and it’s [common for] any age category, but it’s really important for women to be aware of this.

“[For] men, on the other hand, sometimes sex can be a little bit easier. When they are undergoing stress or illness, a lot of times sex is a stress reliever. But for women, sex becomes more of a chore in circumstances where they’re busy and they’re caring for other people. It’s really important for them to realize that sometimes making sex a priority is what’s necessary.”

Depression

Q: Depression of varying degrees can be pretty common among caregivers, and that can really affect sexual health. How can they treat their depression or anxiety without having a severe impact on this aspect of their lives?

A: “It’s kind of a catch-22. 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 really an individualized approach that’s needed to help. But I strongly encourage, for a variety of reasons, to never let depression go untreated. (I hate to say untreated, because I think that people think that means with medication, but there’s a lot of ways to treat depression.)

“When women are stressed, that’s a very common experience, to feel depressed or to experience true depression, and I’ve seen that quite a bit in my office. Now, I’m not a psychiatrist or a psychologist, but you really can’t separate that out when you’re dealing with sexual matters, and I really strongly encourage women to seek care [for depression] just like they do for their physical issues.”


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Abstaining from Sexual Activity

Whether or not you have voluntarily decided to forego sexual relations, or have simply encountered a dry spell due to caregiving, divorce or other extenuating circumstances, Faught encourages women to try to keep the spark alive. Women who have given up on the thought of having intimate relations may eventually find themselves wishing 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 and sensation and so forth.”

Essentially, Faught is saying is that 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.

Other Options for Treatment

Q: What are some non-medical treatments for women who may be experiencing sexual issues?

A: “The way that I practice sexual medicine is holistic, which means that I treat the entire body, and that includes the mind as well. So, for my women, we really look at the entirety of the situation. Certainly we’re going to include medicinal options when appropriate. [For instance,] acknowledging if there’s relationship discord or there’s stress—maybe counseling can be beneficial. Sometimes physical therapy for the pelvic floor can be beneficial. And, a lot of times, using all of these combined as a team effort, and using some of these other treatments as an adjunct to medicinal treatment can improve the efficacy of the game plan.”

“[Another] thing to keep in mind is some people think about lubricants and moisturizers as another alternative option. That’s fantastic, and I recommend those frequently (glycerin free lubricants and coconut oil). The problem is that’s really kind of putting a band aid on the issue. If a woman just has mild symptoms, sometimes that’s all that 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 change the physiologic changes that have happened with menopause.”

Taking the Next Steps

Faught recommends having candid discussions with your physician in order to affectively address any iddues 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 a medical aspect, but also psychological, et cetera.”

Regardless of your unique situation, caregiving, stress, emotional health, and menopause can all have detrimental effects on a woman’s sexual health. Rather than 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.