an excuse to stop sex completely after years of disinterest. Many physicians, however, question if declining interest is the cause or the result of less frequent intercourse. Some women actually feel liberated after menopause and report an increased interest in sex. They say they feel relieved that pregnancy is no longer a worry.

For women in perimenopause, birth control is a confusing issue. Doctors advise all women who have menstruated, even if irregularly, within the past year to continue using birth control. Unfortunately, contraceptive options are limited. Hormone-based oral and implantable contraceptives are risky in older women who smoke. Only a few brands of IUD are on the market. The other options are barrier methods -- diaphragms, condoms, and sponges -- or methods requiring surgery such as tubal ligation.

Sexuality in Menopause: Finding Your Sexual Energy and Truth

Do you remember the first time you fell in love? Chances are, you thought you had discovered the moon and the stars. The lyrics to songs seemed to be written about you. And you probably didn’t even think about eating or sleeping. When a woman falls in love, she experiences an almost-overwhelming influx of energy, filling her with exhilaration, benevolence, vigor creativity, and often insatiable sexual desire.

This first-love feeling can be experienced at any life-stage or age when we are able to connect at a deeply emotional and spiritual level with another person. But at midlife, the challenge for most women is to be able to access that in-love feeling in ways other than looking to another person for fulfillment and gratification. In other words, if you think of sexual energy in the largest possible context — as life force, or Source energy — then it is easy to see that the health and vitality of our sexuality is inexorably linked to the health and vitality of our lives.

Sexual Problems at Midlife

It is a common misconception that sexual desire and activity inevitably decrease at menopause. Although this is true for some women, it certainly doesn’t have to be the truth for all. What we believe about sexuality at menopause has a lot to do with our sexual expectations and experience. And many women who are in the process of negotiating how to tap into their source energy at midlife notice a decrease in sexual desire. In one study 86 percent of women reported some form of sexual dysfunction, usually in the form of loss of sexual desire, often associated with vaginal dryness, dyspareunia (pain during intercourse), vaginismus (painful spasms in the vaginal muscles), loss of clitoral sensation, and touch sensation impairment.

Determining the cause of sexual problems can be difficult. Sometimes, menopause-related hormone deficiency is to blame. But sexual function is a complex, integrated phenomenon that reflects the physical health of not only the ovaries and hormone balance, but also the cardiovascular system, the brain, the spinal cord and the peripheral nerves. In addition, there are almost always underlying psychological, sociocultural, interpersonal and biological influences that affect individual sexual function. Interestingly, of the 14 percent of women in the study who reported no sexual problems, one-third admitted they had previously had sexual problems but that the problems had been resolved when they found new sex partners.

It is also important to note that health conditions and medications may also interfere with sexual functioning. Women suffering from gynecological problems, hypertension (high blood pressure), diabetes, chronic pain, alcoholism, drug use (including cigarette smoking), thyroid deficiency, or depression, as well as those who use anti-hypertensive medications, tranquilizers or sedatives, ulcer medications, glucocorticosteroids, antihistamines, or antidepressants may suffer some sexual dysfunction.

Perimenopause and Your Sex Life

Many of the following midlife changes in sexual function have been associated with normal perimenopause:

• Increased sexual desire
• Change in sexual orientation
• Decreased sexual activity
• Vaginal dryness and loss of vaginal elasticity
• Pain or burning with intercourse
• Decreased clitoral sensitivity
• Increased clitoral sensitivity
• Decreased responsiveness
• Increased responsiveness
• Fewer orgasms, decreased depth or orgasm
• Increase in orgasms, sexual awakening

As you can see by this list, change, itself, and not the nature of the change, is the common theme. It’s important to remember that during the perimenopausal transition, with all of its changes, a woman’s libido may go underground for a while as she reprioritizes her life and the manner in which she uses her energy. This is perfectly normal and can yield great dividends. But, it is only temporary. There is no reason for diminished sex drive to become permanent after menopause. And, while some women truly do notice a decline in libido at menopause, others actually experience heightened sexual desire and activity after menopause.

Our Cultural Inheritance

There can be any number of cultural influences that contribute to a woman’s inability to feel sexual during the menopause transition. However, I believe that our patriarchal society greatly influences how women perceive themselves at midlife and beyond. For one thing, there is an inherent double standard with regard to sexuality in our culture. If you don’t believe me, all you have to do is check out the number of Internet sites that sell Viagra to men without a prescription. (Women still cannot get birth control pills anywhere without a prescription.) While there is no question that Viagra can increase the quality of life for couples in which the male partner suffers from erectile dysfunction, our culture is quick to overlook the holistic nature of sexual function and how profoundly it is enhanced when a couple is truly connected in all ways. But because our patriarchal culture associates sexuality with genitalia, it is easier to create a pill that allows men to have reliable erections without having to connect their hearts with their penises.

Another bias against women is that we live in an ageist culture where a woman who is young and fertile is valued more than a woman who is no longer able to reproduce. This is seen everywhere from the conventional medical mindset, which treats menopause as an estrogen deficiency disease, to TV commercials that imply that, as soon as a woman reaches menopause, it’s all over — her bones will dissolve right from under her, she will lose her libido, and without “help” she will wither up and die and like the barren trees and parched earth featured on the cover of one issue of Menopause Medicine. It is no wonder many women lose their interest in having sex, because they cannot adjust psychologically to aging or their loss of fertility.

Baby Boomers may be particularly sensitive to ageism because this is the societal attitude that influenced them while they were young. The fairy tales Baby Boomers learned were about beautiful young girls being rescued by handsome princes. In many of these fairy tales, there was a Crone, living alone in the woods. Often she was depicted as a witch or some other eccentric outcast of society and a foe of the beautiful young girl. Today the fairy tale is depicted in media images so Boomers continue to be reminded of how youth-oriented our society still is. Just turn on the TV and you will see thin, scantily clad girls selling everything from men’s shaving cream to Doritos. This only perpetuates the idea that once a woman reaches menopause, she is not sexy.

Caroline Myss points out that the image of the Crone alone in the woods symbolically represents a woman who has freed herself from her original tribal programming. She no longer bases her activities, thoughts, and self-image on the approval of her family. She is free to come and go as she pleases on her own terms. She does not need to be alone, but her relationships are more likely to be partnerships and mutually satisfying; and this includes her sexual relationships. If women continue to believe that menopause marks a significant decline in health and happiness, this belief will translate into a reality that could be perpetuated for generations to come. On the other hand, if you update your understanding of the Crone or Wise Woman archetype you will create the capacity to stay strong, attractive and vital through menopause.