France will begin offering free condoms in pharmacies for people up to age 25 starting Jan. 1, in a bid to reduce the spread of sexually transmitted diseases, President Emmanuel Macron said on Friday.
“It’s a small revolution for prevention,” Mr. Macron said as he announced the news in a video message posted on Twitter.
The move comes as health authorities have observed an increase in sexually transmitted infections, such as chlamydia and gonorrhea, in recent years. But it is also part of a broader public health campaign that has led France to expand free access to contraception and screening for sexually transmitted diseases.
Mr. Macron said that “regarding sexual health” of young people, “we have a real issue,” according to reports from French news outlets present at the debate. And he acknowledged that, when it comes to sex education, “We’re not good on this topic.”
The French president had initially announced on Thursday, during a health debate with young people, that the measure would only apply to people ages 18 to 25. But on Friday — after several people and activists called him out on the fact that minors, too, were at risk of contracting sexually transmitted diseases — Mr. Macron announced that he was extending the policy to underage people.
“Let’s do it!” Mr. Macron, who by the evening had traveled to Alicante, Spain, for a European summit, said in the video message.
Since 2018, people have been able to get the cost of condoms reimbursed by the national health system if they were purchased in a pharmacy with a prescription. But the measure is not well known to young French people. And more than a quarter of them say they “never” or “not always” use condoms during sexual intercourse with a new partner, according to a study released last year by HEYME, a student health insurance company.
“Condom use is very low, especially among young people,” said Catherine Fohet, a gynecologist and top member of the National Federation of Institutes of Medical Gynecology. She said the price of condoms can be prohibitive but also pointed to their “bad image” as devices that reduce tactile sensation.
French health authorities say that sexually transmitted infections, or S.T.I.s, have been on the rise in recent years, especially among young people, as a result of a decline in the use of prevention methods.
Recently released figures show that the number of people infected with chlamydia rose last year by 15 percent compared with 2020, and more than doubled compared with 2014, based on data from screenings at private health centers.
Meanwhile, gonorrhea infections have been growing since 2016, and H.I.V. infections, which condom use had helped curb in the 1980s and 1990s, have stagnated around 5,000 from 2020 to 2021.
“There’s an explosion of S.T.I.s,” said Jérôme André, the director of HF Prévention, an association that organizes screenings among university students. He added that in some universities of the Paris region, the rate of S.T.I.s reached 40 to 60 percent of those tested.
“We end up testing tons of people who should not be infected,” Mr. André said.
Mr. Macron said in a message posted on Twitter following his announcement that other health measures would be implemented as part of a recently passed health care law. They include free emergency contraception for all women in pharmacies and free testing for sexually transmitted infections without a prescription, except H.I.V., for people under 26.
Ms. Fohet welcomed Thursday’s announcement, but she said free condoms “won’t solve everything.” She added that “education and information” were key to convincing people to use protection during sexual intercourse.
Mr. Macron acknowledged on Thursday that France needed “to train our teachers much better on this topic, we need to raise awareness.”
Help for sexual side effects from cancer treatment is out there — but you may need to ask for it.
The impact of cancer treatment on women’s sexual health, and how to mitigate it, was highlighted at the 2022 North American Menopause Society annual meeting.
When it comes to sexual dysfunction caused by cancer treatment, most women suffer in silence.
With significant advances in oncology care, the majority of women and girls diagnosed with cancer will go on to become long-term cancer survivors. An estimated 89 percent of female cancer survivors are age 50 and older, according to the American Cancer Society.
That is no small number of women, and the North American Menopause Society (NAMS), a leading medical association dedicated to promoting the health and quality of life of all women during midlife and beyond, focused on women facing the issue at this year’s annual meeting in Atlanta in October. Sharon L. Bober, PhD, an associate professor at Harvard Medical School and the director of the sexual health program at Dana-Farber Cancer Institute in Boston, presented on the topic of sex and cancer.
Cancer Treatment Can Impair Sexual Function
Every major type of cancer treatment — surgery, radiation, chemotherapy, and hormonal therapies — has the potential to disrupt or impair sexuality and sexual function, according to Dr. Bober.
More than two in three women with cancer, or 66 percent, will experience sexual dysfunction, according to a meta-analysis published in January 2022 in the International Journal of Reproductive Biomedicine. This can encompass various aspects of sexual function, such as desire, arousal, and orgasm as well as other aspects of sexual health such as sexual satisfaction and perceived body image.
Yet, despite how common these issues are, most women cancer survivors do not receive adequate information, support, or treatment, says Bober. Studies suggest that most oncology providers lack training in this aspect of patient care, are not familiar with validated tools to efficiently identify patients with sexual problems, and do not feel knowledgeable about available resources.
Ask About Potential Sexual Side Effects
Both patients and oncology providers report they do not want to make each other uncomfortable, which means that the problems go unaddressed. Women undergoing cancer treatment should ask their providers about sexual side effects. “I think women need to ask their oncology providers if treatment will result either in menopause or an increase in menopausal symptoms so they can be proactive about seeking help if necessary,” says Bober. Chemotherapy or radiation therapy to the pelvis are examples of cancer treatments that may trigger menopause, she says. This can lead to genitourinary symptoms of menopause (GSM), which can include vaginal dryness or burning, issues with urination, recurrent UTIs, tightening of the vagina canal, and discomfort with intercourse.
Commonly Reported Problems During and After Cancer Treatment
In addition to GMS, other commonly reported symptoms can include psychological distress (including distraction and avoidance), decreased desire and sexual satisfaction, body image distress, loss of sensation and body integrity, relationship stress, and dating challenges.
Because support for sexual health and sexual recovery is not yet a standard part of oncology care, it’s especially important to be able to identify changes that are bothersome and then specifically seek out resources as needed, says Bober.
Sexual Aids Can Help Address Symptoms That Contribute to Sexual Dysfunction
Sexual health resources can include vaginal lubricants and moisturizers, dilator therapy (a tube-shaped device that can help stretch the vagina), and pelvic floor exercises, all of which may help women with genitourinary symptoms, says Bober.
Online Resources for Finding Help With Sexual Dysfunction
Depending on your issue, Bober recommends finding an expert who can help; for example, a provider certified in menopause care or a therapist who has experience with sexual health after cancer.
Sexual side effects of treatment do not typically resolve on their own; that’s why being proactive is so important, she emphasizes. For some women, a physical therapist who has specialized training and expertise around the pelvic floor may be useful, says Bober. Not every PT has this type of training, she cautions. The American Academy of Pelvic Health Physical Therapy offers a guide to nearby therapists who are certified in pelvic health. Sexual dysfunction is also associated with anxiety, depression, relationship stress, and loss of self-efficacy (belief in one’s ability to complete a task or achieve a goal).
Sexual issues that arise as a result of cancer treatment don’t just impact quality of life; they can also impact adherence to cancer treatment, says Stephanie S. Faubion, MD, the Penny and Bill George Director of the Mayo Clinic’s Center for Women’s Health and the medical director of the North American Menopause Society. In fact, sexual symptoms are the primary reason for premature discontinuation of treatment or failure to initiate therapy. “If women are actually stopping their therapies because of sexual dysfunction, that doesn’t help anybody,” she says.
More Cancer Centers Offer Treatment, Support for Sexual Dysfunction
Bober recommends an approach that takes into account the physical, mental, social, and cultural issues that contribute to sexual dysfunction related to cancer, which she calls a biopsychosocial model.
On a positive note, there is evidence that this may be changing for the better, says Bober, with increased interest in the treatment of cancer-related sexual dysfunction, including medications, physical therapy, and counseling options. Some of these options are being offered at cancer centers.
At the Dana-Farber Cancer Institute where Bober is the director of the sexual health program for cancer patients and survivors, the healthcare team includes a psychologist specializing in sexual rehabilitation counseling for men, women, and couples, a gynecologist specializing in female sexual health, a urologist with expertise in male sexual health, an endocrinologist who focuses on hormonal changes after cancer treatment, a reproductive endocrinologist who specializes in fertility issues after cancer, and a fertility expert specializing in fertility and reproductive health during and after cancer treatment.
Physical changes in your body due to breast cancer treatment paired with feelings of loss and fear can reduce libido (sex drive) and ultimately lead to depression.
It’s important to have open communication with your healthcare provider if you’re experiencing sexual problems after a breast cancer diagnosis.
This article will discuss how breast cancer affects sexual health and ways to prevent or treat sexual problems associated with breast cancer
Connection Between Sexual Problems and Breast Cancer
Although chemotherapy, hormone therapy, surgery, and radiation are needed to treat, cure, or prevent breast cancer, they can also cause sexual dysfunction. Due to hormone fluctuations, medication side effects, and poor body image, sexual health is greatly affected by breast cancer. Intercourse is not usually dangerous; however, sex can be painful for women, and men may experience erectile dysfunction.
Does Breast Cancer Treatment Cause Sexual Problems
The following are ways breast cancer treatment can cause sexual dysfunction in men and women:12
Chemotherapy: Certain chemotherapy agents (anthracyclines and taxanes) have toxicities that reduce sexual arousal and desire. These medications cause fatigue, nausea, and diarrhea, all of which can lead to decreased interest in sex and intimacy.
Hormone therapy: Hormone receptor-positive breast cancers are often treated with aromatase inhibitors and selective estrogen receptor modulators, which cause hot flashes, vaginal dryness, insomnia, and painful intercourse in women. Men on hormone therapy for breast cancer can experience low libido and erectile dysfunction.
Surgery: Breast surgeries (mastectomy, which is removal of the breast, and lumpectomy, which is removal of the cancerous tumor) and sentinel lymph node dissection (lymph node removal) result in emotional and physical distress. Pain, numbness, and swelling of the surgical site can cause discomfort, while the scars from surgery can lead to poor body image.
Radiation: Radiation therapy can result in persistent pain, lymphedema (swelling), reduced flexibility, and pain in the affected breast, arm, and axilla (armpit). Studies show these side effects correspond with poor quality of life, including sexuality.
How Are Sexual Problems With Breast Cancer Treatment Alleviated?
Following your treatment regimen is essential to surviving and thriving with breast cancer. These tips may help prevent or alleviate sexual problems from breast cancer treatment in men and women:3
Be open and honestly communicate your feelings with your partner.
Try sex in different positions until you find one that’s comfortable.
Intimacy isn’t just about sex. Kissing, snuggling, and touching can also provide intimacy.
Use lubrication to help make sex more comfortable.
Some antidepressants are used to improve sexual desire.
Sexual rehabilitation/therapy can help assess and treat sexual dysfunction in people with breast cancer.
Studies show that healthcare providers don’t always provide sex education to patients with newly diagnosed cancer. Be sure to discuss this topic with your oncology team before treatment starts so you know what to expect.4<
Symptoms and Gender Differences
While breast cancer is the most common cancer in women (after skin cancers), male breast cancer is rare. However, both genders experience symptoms of sexual dysfunction with breast cancer.
Men
Because male breast cancer makes up less than 1% of the total breast cancer cases yearly, information about breast cancer in men is significantly lacking. One study found education about sexuality was the most frequent unmet information need reported by male breast cancer survivors.5
Common sexual problems men with breast cancer may experience include:
You will likely need to ask your healthcare provider how your treatment will affect your sexuality, as little information is shared with men on this topic.
Women
Symptoms of sexual problems in women with breast cancer include:
Although there is a great deal of information about how breast cancer affects the sexual health of women, you will likely need to ask for education on this topic as well.
How Are Sexual Problems With Breast Cancer Treated?
The first step in treating sexual problems with breast cancer is to speak to your healthcare provider. Whether male or female, sharing your new or worsening sexual side effects with your oncology team is vital. Additionally, being referred to a sex therapist or for sexual rehabilitation can help assess and diagnose the dysfunction and formulate a treatment plan that fits your individual needs.
It may also help to do the following:
Premenopausal women with breast cancer may improve libido by using Addyi (flibanserin), a prescription medication that increases sexual desire.
All women with breast cancer should use lubrication to prevent painful intercourse. Ask your healthcare provider about topical lidocaine if lubrication doesn’t improve comfort during sex.6
Men with breast cancer experiencing sexual problems may find relief from oral medications that help get and keep an erection. Other medical options include penile injections, urethral pellets, vacuum erection devices, and penile implants.6
For both men and women, the following may help improve sexual problems associated with breast cancer:
Egg and sperm donation before starting cancer treatment
Check with your healthcare provider before implementing any new treatments for sexual dysfunction.
Summary
Whether you’re male or female, you will likely experience sexual problems if you have breast cancer. The consequences of cancer treatments such as chemotherapy, hormone therapy, surgery, and radiation can cause sexual dysfunction leading to depression. Speaking to your healthcare provider about how breast cancer will affect sexuality is important as there are ways to prevent or alleviate these side effects.
A Word From Verywell
Changes in appearance from breast cancer surgery can greatly influence body image and self-esteem in both men and women. Weight gain or loss, hair loss, breast removal, and scars can make you feel self-conscious. It’s important that you don’t feel rushed into sex until you’re ready. Enjoying other ways to feel close to your partner is equally as satisfying. Be sure to seek help from your healthcare provider if new or worsening sexual problems occur.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Libido (also called sex drive) means the overall interest a person has in sexual activity. It is separate from sexual arousal, which is the body’s response to sexual stimuli. A low libido does not always indicate a problem, but it may be related to a medical condition or can cause a person distress, particularly if there has been a drop in libido.
Statistics vary, but up to 20% of men experience low libido sometime in their life. Up to 43% of women experience sexual dysfunction—a problem that occurs during any part of sexual activity, from arousal to orgasm—at some point, including low libido. About 1 in 3 women report having a low sex drive.123
Low libido itself is not considered a condition. If certain criteria are met, however, a woman with low libido may be identified as having female sexual interest/arousal disorder (FSIAD).4
Some references, particularly those published before 2013, refer to low libido as hypoactive sexual desire disorder (HSDD). Since then the definitions for low libido and HSDD conditions have changed. In 2013, the official handbook that classifies mental health disorders, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), combined the two diagnoses and now refers to it as sexual interest/arousal disorder.45
Read on to learn about low libido, when it’s considered a problem, and what can be done about it.
Symptoms of Low Libido
A person with low libido may experience:6
Little or no interest in any type of sex, including masturbation
Rare, if any, thoughts about sex or sexual fantasies
FSIAD is marked by a lack (or serious reduction) of sexual interest or arousal in women. To meet the criteria for FSIAD, a person must show an absence or reduction in at least three of the following, for at least six months:5
Interest in sexual activity
Initiation of sexual activity and being unreceptive to a partner’s attempts to initiate
Sexual or erotic thoughts and fantasies
Sexual interest/arousal in response to sexual or erotic cues
Sexual excitement or pleasure during sexual activity
Genital or nongenital sensations during sexual activity
The symptoms the person experiences also must cause them clinically significant distress and not be better explained by factors such as a nonsexual mental health disorder, severe relationship distress, or another significant stressor.
<h3″>What Is the Sexual Response Cycle?
Sexual desire: A person’s interest in sexual activity
Sexual arousal: Excitement/physical response
Orgasm(climax): Peak of sexual excitement (when pleasure is highest), and ejaculation occurs
Resolution: The body recovers and returns to its usual state
Causes of Low Libido
A number of factors can cause low libido, including that it may be a person’s natural preference. Libido commonly lowers with age for all genders.3
>Most research on low libido focuses on cisgender men or cisgender women. More research is needed to examine low libido in people who do not fall within this narrow gender binary.
Medical conditions: Such as diabetes, cardiovascular disease, fibroids, underactive thyroid, endometriosis, premenstrual syndrome (PMS)
Medications: Including many antidepressants and antipsychotics
Psychological distress: Stress, anxiety, exhaustion, problems with body image, etc.
Depression: Can cause a loss of interest in things once enjoyed, including sex
Relationship problems: Overfamiliarity with partner in long-term relationships, conflict, partner’s lack of interest/functioning in sex, etc.
Dissatisfaction or discomfort during sexual activity: Such as erectile dysfunction, problems with ejaculation, vaginismus (involuntary tightening of the muscles around the vagina before penetration), difficulty with orgasm, vaginal dryness, or pain
Substance misuse: Excess amounts of alcohol can affect libido, as can drug misuse and/or smoking
Life stage or event: Such as menopause, pregnancy, postpartum, breastfeeding, loss of a loved one, retirement, job loss, divorce, illness, etc.
Trauma: Such as a history of unwanted sexual contact or post-traumatic stress disorder (PTSD)
A 2017 study also identified high levels of chronic, intense, and greater durations of endurance training on a regular basis, as a possible contributor to decreased libido in men.10
What Medications Can Cause Low Libido?
Medications that may cause low libido include:31112
Medications that block the effects or reduce the production of testosterone, such as Tagamet HB (cimetidine), Propecia (finasteride), and Androcur (cyproterone)
Is Low Libido Always a Problem?
Having a low (or no) libido in and of itself can be perfectly normal for a person. Comparing your libido to someone else’s, including your partner’s, is not an accurate way to determine if your libido is “too low.”12
There is no set amount of sex that’s considered “normal.” A person may be content thinking about or having sex once a year, while another person may be unhappy with sexual activity once a week.136
Unless your low libido is a symptom of a health condition that needs to be addressed (such as diabetes, depression, etc.), the level of your libido is only a problem if it is bothering you.2
Supplementation of testosterone in those with low testosterone levels may help with low libido, but should only be attempted under the guidance of a healthcare provider who is knowledgeable about this treatment.11
Those who have been through menopause (either naturally or surgically) with low libido may benefit from transdermal testosterone therapy (with or without accompanying estrogen therapy). However, data on the benefit of testosterone therapy are limited and inconsistent, and there is a lack of long-term data on safety and effectiveness.
Hormone treatment comes with risks as well as benefits. Talk to your healthcare provider about whether taking hormones is appropriate for you.1
Medication
If low libido is a side effect of medication, talk to your healthcare provider about changing the dose or type of medication you are on. In some cases, another medication, such as the atypical antidepressant Wellbutrin (bupropion), may be added to help address the sexual dysfunction.12
Flibanserin
In 2015, the Food and Drug Administration (FDA) approved the medication Addyi (flibanserin) for use in the treatment of FSIAD of any severity in people who are premenopausal.5
Reported side effects include:
Headache
Dizziness
Fatigue
Drowsiness
Nausea
Flibanserin carries a boxed warning (the strongest FDA warning) for hypotension (low blood pressure) and syncope (fainting) in certain settings, particularly with the use of alcohol and/or moderate or strong CYP3A4 (an important drug-metabolizing enzyme) inhibitors, and for people with liver impairment.
Alcohol should be avoided during the entire course of treatment with flibanserin.
Flibanserin is taken daily as an oral pill.2</span
Long-term studies on flibanserin are needed. The benefits of flibanserin in improving sex drive are minimal compared to placebo, and in many cases are outweighed by the risks of using it.
Before taking flibanserin, it’s important to discuss these benefits vs. risks with a healthcare provider who is knowledgeable about this medication.
Bremelanotide
Vyleesi (bremelanotide) was approved in 2019 for treatment of HSDD in people who are premenopausal.14
Bremelanotide is taken as needed, about 45 minutes before sexual activity, as an injection in the thigh or abdomen.2
Evidence on efficacy is limited, and shows minimal effect on the number of satisfying sexual events compared to placebo.
The most common side effects of bremelanotide are:14
Nausea (about 40% of people who took bremelanotide in clinical trials experienced nausea and 13% needed medication to treat the nausea)
Vomiting
Flushing
Injection site reactions
Headache
People with uncontrolled high blood pressure, with known cardiovascular disease, and those at high risk for cardiovascular disease should not take bremelanotide.
Address Underlying Medical Conditions
If your low libido is caused by a health condition, managing that condition may improve your libido.111
General healthy lifestyle practices, such as eating nutritious foods, being physically active, and getting enough quality sleep, may help improve your libido.6
For some people, engaging in sexual stimulation and triggering the arousal response can help the person “get into it,” even if they weren’t desiring sex before. While this may be helpful for some people, no one should feel pressured to engage in sexual activity if they don’t want to.12
Relationship Strategies
Open and honest communication with your partner about your sexual desires can help both of you feel sexually fulfilled.11
You may also benefit from psychosexual counseling, which can help you and your partner work through sexual, emotional, and relationship issues that may be affecting your libido.3
Remember that sex is more than intercourse. There are activities you can do together that can “spice things up” or let you engage in intimacy without having sex. Some things to try include:136
Exploring each other’s bodies through caressing, kissing, etc.
Giving and receiving massages
Bathing or showering together
Experimenting with different sexual techniques
Using aids such as toys or massage oils
Planning romantic activities or taking a weekend away
You may also find that self-exploration helps you find what works for you.
Are There Tests to Diagnose the Cause of Low Libido?
To look for a cause of low libido, your healthcare provider may:11
Ask about history of low libido (when it started, severity, situational and/or medical factors around the time it started, previous treatments, and if there other sexual problems present, etc.)
Get a general medical history, including medications and mental health
Refer you to a specialist if needed (such as a mental health professional if FSIAD is suspected)
When to See a Healthcare Provider
loss of libido, especially if prolonged or recurring, may be an indication of an underlying problem. It may be a good idea to see if there are potential medical or psychological reasons that should be explored.3
Even without a medical reason, if your low libido bothers you, talk to your healthcare provider.
Summary
A low libido means little or no desire to engage in sexual activities. It may be linked to a medical condition, medication, relationship issues, hormones, and other factors. It may also be normal for that person.
Unless there is an underlying medical condition, low libido is only a problem if it causes the person distress.
Treating unwanted low libido depends on the cause, but may include medication, therapy, lifestyle changes, hormone therapy, and/or relationship building.
A Word From Verywell
If you have a low sex drive that is not caused by a medical condition and isn’t bothering you, then it is not a problem. If you are bothered by your low libido or are concerned about what may be causing it, talk to your healthcare provider. A medical professional can help you figure out what is going on and how best to approach it.
Frequently Asked Questions
Is low libido the same as low arousal?While related, libido and arousal are different. Libido refers to a person’s overall interest in sexual activities. Sexual arousal is how the body responds to sexual stimuli (“turned on”).
Is low libido normal?For some people, having a low libido is normal. A low libido is only a cause for concern if it is caused by a medical condition or if the person does not want to have a low libido.
Does low libido vary by gender?
Women are more likely than men to experience low libido. The causes of low libido can also depend on gender.
Most studies on low libido include cisgender people only. More research is needed to understand how libido affects people across the gender spectrum.
Cast your mind back to your secondary school sex education lessons: does the very thought of it make you cringe?
Because shockingly, putting condoms on bananas and labelling diagrams of vulvas is quite limited. In fact, a 2016 study found that almost three-quarters of pupils are not taught about important issues like consent and at least 95% don’t receive education about lesbian, gay, bisexual and transgender relationships in school.
Therefore it’s no surprise that when it comes to STIs, even though there were 317,901 diagnoses of STIs made in England in 2020, there’s still plenty we don’t know or get wrong.
Over 70% of men and over 85% of women are classified as having had unsafe sex in the past year, but 64% of men and 73% of women said they perceived themselves as not at all at risk for STIs.
So to mark sexual health week, Valentina Milanova, founder of Daye, a gynaecological health company that is committed to raising the standards in gynae health, is helping Stylist to dispel some of the most common myths.
Myth: all STIs have symptoms
One of the most common myths associated with sexual health is that all STIs have symptoms. However, Milanova explains that some 70% of female STIs are asymptomatic, so you won’t know you have an STI unless you get tested. “This is why it’s extremely important to get tested regularly, even if you are in a monogamous relationship,” she says.
Myth: STIs will eventually disappear without treatment
Unfortunately, STIs will not go away by themselves. However, most STIs can be treated with a simple course of antibiotics. “Early detection is important,” Milanova suggests. “Like other infections, the longer an STI is left untreated, the more serious the potential health implications become.”
Myth: condoms can protect against all STIs
While condoms are generally great at protecting against STIs such as chlamydia and gonorrhoea, you can still catch herpes, genital warts and syphilis even if you always practise protected sex. “This is why it’s important to ensure that both you and your partner get tested regularly, even if you do use a condom when having sex,” repeats Milanova.
Myth: STIs only affect young people who have sex frequently with multiple people
Actually, anyone who is sexually active can contract an STI, no matter their gender, age, or sexuality. STIs do not discriminate and are perfectly normal.
Myth: the contraceptive pill protects against STIs
The pill can prevent pregnancy, but it cannot stop you from catching an STI. The most effective way to protect against STIs is by using a condom.
Everyone awaits the day when the COVID-19 pandemic will end. Yet, backlash caused by the SARS-CoV variant is far from over for COVID long-haulers who continue to be ill long after they experience their first symptoms.
Despite the worldwide burnout known as “COVID fatigue,” sexual long COVID may motivate the global community to continue its best efforts to prevent the spread of coronavirus variants.
Below are a few possible symptoms of long COVID leading to sexual long COVID:
Erectile dysfunction in males; emotional distress and low libido in females
Circulation disorders that block blood flow to the genitals
Brain fog, including confusion, forgetfulness, inability to concentrate or stay awake during sex
Endocrine disorders involving a new onset of diabetes, thyroid disease, or low testosterone levels
Anxiety and depression related to long-haul problems that suppress libido
Sensory dysfunctions or nerve pathway disorders causing tingling or pain in hands and feet
Musculoskeletal pain and joint tenderness that makes intimate activity uncomfortable
Brain events (such as strokes) and cardiac dysfunctions ranging from extra beats to heart attacks
Lung problems like shortness of breath, cough and chest discomfort that deter intercourse
Many physicians tell survivors they have no measurable COVID-19 after-effects and blame nuisance symptoms like poor sexual performance on “pandemic stress.” Unfortunately, these misdiagnoses diminish the COVID survivor’s plea for help.
Moreover, physicians don’t discuss sexual health issues unless the patient mentions the problem first — many patients are too embarrassed to report sexual performance issues while struggling to recover, so sexual long COVID often goes untreated.
Anita’s COVID Nightmare
Sixty-four-year-old Anita (a pseudonym), who lives in The Villages in Florida, caught COVID-19 in December 2021. She tested positive after developing a fever, fatigue, and cough. She soon became short of breath and struggled to perform simple tasks.
Anita went to the Emergency Department and was in intensive care for five days because of low oxygen levels caused by COVID pneumonia. She reported feeling death anxiety as soon as her hospitalization began, and her thoughts about death persisted for months.
To this day, Anita has not fully recovered from COVID-19 because of her anxiety and shortness of breath. This fear affects her love life. She also claims that experiencing COVID-19 is still her most debilitating issue.
“Before I discovered that my illness caused me to develop asthma, I would wake up in the middle of the night and feel so confused. It took weeks to realize that I was awakening because I was short of breath.”
“I admit to having significant problems with my love life because I am afraid sexual activity will trigger an asthma attack.”
Fortunately, after months of doctor’s visits, testing, and medication trials, Anita reports her asthma to be in better control. “I now depend on two inhalers, especially when I exert myself. I cannot hike or exercise like I did before I got sick without having an asthma attack.”
“However, I admit to having significant problems with my love life because I am afraid sexual activity will trigger an asthma attack. I’m hopeful I’ll one day feel as well as I did pre-COVID. I don’t have the same quality of life since long COVID impacted my world. I’m so glad my husband didn’t catch my infection, but I think he knows my illness has damaged our love life.”
Anita’s experience of having to endure months of doctor visits and testing confirms how hard it was for her to get the health care she eventually received for her breathing issues.
Her primary care physician kept telling her that she was imagining her long COVID problems and suggested she needed a therapist. She admits that no one has asked her if COVID-19 has affected her sexual health.
Long COVID and Tiny Blood Clots
Clyde Goodheart, of Fort Lauderdale, Florida, is a biomedical research scientist who studies viruses and other disease causes. Goodheart believes that long COVID complications are likely due to “micro clots” that block blood flow to multiple affected organs.
According to Goodheart, “COVID long haulers who have problems with breathing most likely have tiny clots in the smallest blood vessels (capillaries) in their lungs.”
Goodheart explains how tiny blood clots cause endothelial dysfunction, which occurs when the linings of blood vessels become damaged, causing circulation to the affected organs to become blocked. Post-COVID endothelial dysfunction contributes to erectile dysfunction (ED) when micro clots impair the circulation inside the penis, which causes problems with getting or keeping an erection.
Genital circulation is not the only organ system affected by impaired circulation; lungs, brain, heart, nerves,and muscles can all potentially be damaged by micro clots that impair circulation.
Erectile Dysfunction as a Marker for Sexual Long COVID
A study by the University of Florida Health (UFH) shows that men infected by a SARS-CoV-2 variant are three times more likely to develop erectile dysfunction than men unaffected by infection.
Here’s what UFH researchers discovered:
In men who suffered significant COVID-19 infections, those with increased risk factors for COVID-19 complications were most likely to develop long-term ED.
Complication risk factors include prior history of diabetes, lung disease, obesity, circulation or heart disease and smoking.
The virus binds to primary organ tissues, including the penis and testicles. This bond decreases the amount of testosterone produced and increases the risk of ED. The virus has been found in penis tissue biopsy long after the initial infection.
Testosterone loss increases the risk of developing all other complications associated with long COVID.
The study also confirmed that sexual long COVID causes both genders to experience brain fog, breathlessness, anxiety and fatigue.
The Impact of Sexual Long COVID
It is fair to say that the next global public health crisis may be to care for patients afflicted with life-altering disabilities caused by long COVID.
The threat of sexual long COVID may be psychologically more intimidating to the COVID-weary community than are other long-haul complications. Sexual long COVID may spur more people to vaccinate or to improve their social distancing and other transmission precautions.
Only time will tell how COVID-19 will affect those most affected by the long-term exponential complications. More research and a better understanding of all factors that make COVID-19 an enduring pandemic are needed to provide the best treatment practices for the millions infected worldwide.
Talking about sex with someone you’re newly dating isn’t the easiest thing to do, but these experts in health and wellness share tips on how to go about it.
Having conversations about almost anything relating to sex can be awkward for the average person. However, sex is one of the most intimate things you can do, so talking about it is something we should all learn to get more comfortable with. Sex is a broad topic, which means you have more than enough ground to cover, be it one’s STD status, sexuality, sexual trauma, or sexual kinks. It is essential to mention the gamut of sex as sometimes, we assume the term “sexual health” is only comprised of your STD status.
The World Health Organization defines sexual health as a state of physical, emotional, mental, and social wellbeing as it relates to your sexuality. Since sex is such a broad topic, how can you approach talking about sexual health with a new person you’re dating? Where should you start? Perhaps choose any starting point, and see where the conversation goes from there. What’s most important is actually opening the floor to have the conversation.
“There’s a number of ways to broach the topic,” says Jen Caudle, DO, a family physician and associate professor at Rowan University. She explains that you can initiate the conversation over dinner or coffee. “Pose things as ‘I’d like to talk about something that can be difficult for some people to talk about, but it’s important to me,’ or, ‘Can I talk to you about something that’s been on my mind?’ she says. “Everybody’s going to have a different way to do this based on your personality or style and your relationship with the other person, but letting the other person know that you come from a good place and that you mean well can be helpful.”
Caudle adds that letting the person know you understand conversations around sex can be awkward is a good way to set the tone also.
Once you do get the ball rolling and begin having conversations around the topic, what types of questions should you ask the person you’re newly dating? Asking your prospect how they define sexuality and sexual health is a good starting point says Lorneka Joseph, a pharmacist, coach and speaker. She is also a certified HIV/AIDS counselor and tester.
“Listen to what this person is saying. Is sex, a taboo for them? Do they like talking about sex? Were they sexually abused? [Maybe] they don’t want to talk about sex,” she tells ESSENCE. “I think initially asking their definition [of sexual health] will also break the ice and then you can go into [other] questions, like ‘Do you believe in multiple sex partners?’ ‘Do you believe in threesomes?’ ‘Have you ever had an HIV or STD test?’”
Caudle recommends taking it a step further and going beyond just having conversations about STDs and putting some action behind it. “I recommend people get tested before they’re into it with one another as well. I think that’s very important,” she says.
There is technology you can use to exchange test results, so you’re not simply relying on each other’s word. iPlaySafe is a helpful app you can use to take an at-home STI test and securely share your results with the person you’re seeing. There is also Hula, which enables you to find a pre-verified clinic and have the results delivered from the doctor to your phone. It also tells you how much time has passed since the user was last tested for that extra blanket of safety.
If you already know your STD status and you’re living with an incurable one, disclosing that information can be tough. However, it’s an important thing to consider doing. “I have women clients I coach who have tested positive for STDs, and we are walking through building their confidence and I am teaching them how to break the ice and bring up this information, even though it’s vulnerable,” says Joseph.
The conversations around existing STDs you may have should especially come up before engaging in sexual intercourse. It’s a way to show the person you’re dating you care about their wellbeing and it gives them the chance to choose whether or not they’d like to engage in sexual activities with you.
“If I’m going to say that I care about the person that I’m dating and I am HIV positive, or I just tested for herpes and we’re about to get down, then I believe that that is showing a lack of concern and care because I did not take the time to let this person know, ‘I actually tested positive for herpes,’ or ‘I actually have chlamydia and X, Y and Z.’ That’s showing you don’t care about that person and your relationship.”
Another tip for having conversations around sex is to invite or ask permission of the person you want to speak with. Ask them if they’re comfortable having that talk before diving in, says Joseph. “Sometimes we’ll assume [they] want to talk about sex. Not necessarily, because maybe this new prospect just came out of a relationship where there was no sexual awareness or there was trauma,” she explains.
These are all tips to help you converse in a healthy way about sexual awareness, but there’s no guarantee these conversations will always run smoothly or the other person will be forthcoming. So what happens when said person doesn’t want to talk about their sexual health or disclose any information? Joseph says it could mean that they need to see a therapist about some challenges they’re having or maybe it’s just not the right time to talk about it. However, she says it could also be a red flag to look out for.
“If I’m gonna be vulnerable with you, if we’re gonna be sexually intimate together and you’re not being honest or you are afraid to talk about it, then there isn’t much conversation for us to have.”
Workers with the UK National Health Service take part in the London Pride Parade in 2019.
Personalizing cancer treatment doesn’t only mean matching a drug to molecular markers on a tumour — it should also take into account a person’s sexual identity, interests and wishes.
In 2007, 55-year-old Australian sociologist Gary Dowsett was diagnosed with prostate cancer. On the basis of his relatively young age and his test results, his physicians told him that radical prostatectomy — surgery to remove his prostate completely — was his best option. The procedure went well, but Dowsett had questions — he wanted to know how it would affect his sex life as a gay man, and how to negotiate the physical, sexual and emotional changes that would result from his treatment. For the most part, his questions went unanswered. “Medical professionals were sympathetic, but most knew next to nothing about gay men,” says Dowsett.
Having worked in social HIV/AIDS research for about 40 years, Dowsett, an emeritus professor at the Australian Research Centre in Sex, Health and Society at La Trobe University in Melbourne, was shocked to discover how far behind prostate-cancer physicians and researchers were in understanding men’s sexuality. “It was all about erections, as if sex starts and ends there,” he says. There were no patient-education materials available for men who have sex with men; nor was there much scientific literature. “There was quite a bit for heterosexual men in terms of intimacy with their wives,” Dowsett says. But for gay and bisexual men, who are more likely than heterosexual men to be single when diagnosed with prostate cancer1, and might engage in different sexual practices, little of that applied. “That’s really what got my dander up,” he says.
Physicians might not realize that the needs and concerns of gay and bisexual men are different from those of heterosexual men, says Channa Amarasekera, a urologist and director of the Gay and Bisexual Men’s Urology Program at Northwestern Medicine in Chicago, Illinois. Although the biology of prostate cancer is the same for all, the impact that the disease and its treatments have on a person can vary significantly depending on their sexual orientation and preferred sexual practices.
Dowsett started working in prostate-cancer research after his treatment. He and other researchers have made considerable progress in documenting the experiences of people from sexual and gender minority groups, and uncovering the impact that prostate-cancer treatments have on them. “The quality of life is really affecting some people, and we need to recognize that,” says Daniel Dickstein, a radiation oncologist at Icahn School of Medicine at Mount Sinai in New York City. However, evidence of the problems facing gay and bisexual men will not by itself enable clinicians to advise their patients properly: empowering physicians with evidence-backed guidance, and improving communication, will also be crucial.
Understanding the impact
The prostate, a gland which lies along the urethra between the bladder and penis, is the second most common site of cancer in men worldwide, trailing only slightly behind lung cancer. About one in six gay and bisexual men will develop prostate cancer; there is little research into its incidence in transgender women. But it is only in the past decade that research into prostate cancer specifically in gay and bisexual men has gained interest, says Simon Rosser, a behavioural psychologist at the University of Minnesota in Minneapolis.
Prostate cancer is typically treated by removing the gland through surgery, or by killing cancerous cells using radiation. These can be combined with androgen-deprivation therapy, in which the person’s levels of testosterone are reduced to slow the growth of the tumour.
Common side effects of these treatments include urinary incontinence, erectile dysfunction, a reduced libido and impaired ability to ejaculate. These are broadly similar for all patients, but some differences have been noted between heterosexual men and gay and bisexual men. One study, for example, showed that gay and bisexual men have worse urinary, bowel and hormonal function than heterosexual men after treatment for prostate cancer, but better erectile function2. Similarly, a study led by Jane Ussher, a clinical psychologist at Western Sydney University in Australia, found that gay and bisexual men are more likely than heterosexual men to be able to get and sustain an erection after prostate-cancer treatment3. “One of the reasons for that is that they are more likely to do something about it — like to go and get counselling, try penile injections and suction devices, or use Viagra,” she explains.
In many cases, the impact of sexual dysfunction arising from prostate-cancer treatment is magnified in gay and bisexual men. “Due to differences in sexual practices, they may have additional concerns, and some sexual side effects will be more bothersome or challenging to manage,” says Sean Ralph, a consultant therapeutic radiographer at Leeds Cancer Centre, UK, and co-founder of Out with Prostate Cancer, the United Kingdom’s first prostate-cancer support group for gay and bisexual men and transgender women.
For example, an erection must be 33% firmer for anal intercourse than for vaginal intercourse4. This makes any loss of erection hardness more of a problem for men who engage in insertive anal intercourse — not purely the preserve of gay and bisexual men, but nonetheless a part of many such relationships.
Channa Amarasekera (right) consults with a patient at Northwestern Medicine in Chicago.Credit: Northwestern Medicine
The prostate also acts as an organ of sexual pleasure and orgasm for some people through anal stimulation. “Many men think prostate stimulation is the be-all and end-all in gay sex,” says Rosser. If the prostate is removed, in many cases so, too, is the pleasure for men who have receptive anal intercourse5. Rosser also estimates that one-third of these men experience anodyspareunia, or pain during anal intercourse — double the rate before treatment. And removing the prostate puts a stop to ejaculation. “That was a real blow for me,” says Dowsett. Visible semen can be a sign of a satisfying sexual experience. In a 2013 study, Dowsett and his team found that men who have sex with men were more distressed by the loss of ejaculate than were heterosexual men6.
Communication blockage
A 2016 study led by Ussher found that gay and bisexual men with prostate cancer report significantly lower quality of life and satisfaction with treatment than do heterosexual men1. In some cases, the psychological impact might be made worse by the fact that many people are not made aware of all of the consequences of their therapy beforehand.
Dowsett notes that the loss of the ability to ejaculate after a radical prostatectomy was absent from much of the public-health literature at the time he was diagnosed — he learnt of it only after he went for a second opinion. Similarly, Ussher says that many people are not told that their penis can shorten after a radical prostatectomy, or that this is sometimes temporary. Failure of health professionals to discuss these highly relevant effects of treatments with their patients often leads to lasting anger, distress and harm, says Rosser. “It’s an ethical violation in my mind,” he says.
Physicians also commonly overlook the specific side effects for people from sexual and gender minorities — essentially taking away their ability to make an informed decision about their treatment, Amarasekera says. When physicians do consider a person’s sexuality, there are actions that might improve quality of life. For example, Dickstein suggests that inserting a hydrogel spacer between the prostate and rectum, which reduces the amount of radiation the rectal wall is exposed to, might improve a person’s ability to engage in receptive anal intercourse.
There are also risks that particularly affect gay and bisexual men that could be avoided if physicians are made aware. For example, men are usually advised to resume sexual activity soon after prostate-cancer treatments to help with erectile function, but receptive anal intercourse can cause damage. Clinicians should also consider the use of drugs called poppers in this group of people, Dickstein says. These inhaled drugs, made from chemicals called alkyl nitrites, are commonly used by gay and bisexual men to relax their anal sphincter muscle and enhance sexual pleasure. However, if they are combined with Viagra — often prescribed for erectile dysfunction — the results could be devastating, warns Dickstein. Both drugs lower blood pressure, and the mixture could cause serious cardiovascular problems.
Unfortunately, most physicians do not ask people about their sexual orientation or practices7. “This sets up a don’t-ask-don’t-tell dynamic where patients can’t be honest with you about who they are and what their problems are,” says Amarasekera. Urologists have reported concern about offending their older, more conservative patients by asking about their sexual orientation. “But the majority are not offended,” says Rosser. “All you need to do is ask.” The fact that transgender women are at risk of prostate cancer is also often forgotten (see ‘Targeting treatment for transgender women’).
Targeting treatment for transgender women
Prostate cancer in transgender women is thought to be rare — but it does occur. “Trans women will have a prostate, even if they’ve had gender-affirmation surgery,” says Alison May Berner, an oncologist and gender-identity specialist at the Tavistock and Portman NHS Foundation Trust in London. However, advice for physicians on caring for this population is lacking.
“A lot of physicians forget to check trans women’s prostate,” says Channa Amarasekera, a urologist and director of the Gay and Bisexual Men’s Urology Program at Northwestern Medicine in Chicago, Illinois. And even when they do, subsequent care cannot follow an identical path to that for cisgender men. For example, gender-affirming surgery that some transgender women undertake could be more difficult if they have already had radiotherapy for prostate cancer. “Surgeons do not like operating on parts of the body when they have been treated with radiotherapy,” explains Sean Ralph, a consultant therapeutic radiographer at Leeds Cancer Centre, UK.
There is also no level of prostate-specific antigen (PSA) — a common biomarker for prostate cancer — that is agreed to be cause for concern in transgender women. Gender-affirming hormone therapy artificially suppresses PSA levels, meaning a low PSA reading in a transgender woman might not mean a clean bill of health, as physicians might otherwise assume.
But there are potential positives. Worries that treatments are in some way feminizing might not be an issue for some transgender women or non-binary people. In addition, some scientists think that gender-affirming hormone therapy might actually protect against prostate cancer. A study by researchers in the Netherlands of 2,281 transgender women who received androgen-deprivation therapy and oestrogens found they had a lower risk of prostate cancer than did cisgender men10. “Gender-affirming hormones reduce the testosterone to the prostate which usually drives the cancer,” explains Berner. However, the hormones used in other parts of the world can differ, so the data might not be transferable to other countries.
In many cases, the problem is a lack of education and training among clinicians. Amarasekera has found that many urologists have received less than five hours of instruction on how to treat people from sexual and gender minorities7, and most felt that they needed more.
There is, for example, a lack of guidance on how to discuss the various sexual roles that a gay or bisexual person can take on in anal intercourse, and the implications for treatment. “One might identify as a top or insertive partner, a bottom or receptive partner, or might be versatile and engage in both, and that may change the treatment discussion,” explains Dickstein. In some cases, changing roles after treatment could improve quality of life. However, such a change will not be acceptable for everyone. “It’s not as simple as, I’ll just change a role — both the psychological and social consequences of that are much more complicated and long-term,” warns Dowsett.
It is therefore important that conversations between physicians and patients go deeper than covering just sexual orientation. “You have to move past orientation and understand sexual preferences or interests if you really want to take into account the whole post-treatment experience,” Dowsett says. And this goes for people who are heterosexual, as well — even though the average age of diagnosis is 66, Dowsett says that many people might be willing to try new things, including sexual aids, to improve their quality of life after treatment if physicians are able to discuss it. “It’s very hard to shift the urology and oncology fields to stop thinking about straight men with prostate cancer as being their grandfathers,” Dowsett says.
Culture of trust
Another obstacle to tailoring treatment to gay and bisexual men is that some people might not be forthcoming about their sexual orientation because of mistrust or past trauma. Many people will have had negative experiences with health-care services, says Ralph. For example, one gay man in his support group had surgery without disclosing his sexual orientation because he was worried that his operation would be performed in a careless manner if the clinicians knew he was gay. Others will choose to wait until they have met the physician to decide whether they feel safe to discuss it with them, or simply assume that the physician would be able to tell without having to discuss it openly.
To address this, last year Amarasekera launched a programme specifically to help people from sexual and gender minorities to access care. “There was a significant number of patients who identified as gay or bisexual who felt like there wasn’t a space where they could be open about what their issues were when it came to prostate-cancer treatment,” he says. In 2019, the UK National Health Service (NHS) adopted the rainbow-badge initiative, in which staff can opt to wear a badge that marks them as an ally for LGBT+ people and a safe person to talk to. Clinicians applying for the badge do not receive specific training, but are expected to read some brief information and pledge to promote inclusion. “However, the onus is still on the patient to disclose their sexual orientation or gender identity,” says Ralph.
The guidance available to prostate-cancer clinicians and patients is also improving. The American Society of Clinical Oncology and the US National Comprehensive Cancer Network note that discussions on sexual activity and sexuality are important for cancer treatment, although they still do not address specifics of how to tailor screening or treatment to gay and bisexual men.
In 2021, Ralph published recommendations on anal-sex practices before, during and after prostate cancer interventions8. The advice is based on the opinions of 15 clinical oncologists and 11 urological surgeons in the United Kingdom. It includes recommendations on how to long to wait before engaging in receptive anal sex after radical prostatectomy and radiotherapy, as well as after a biopsy and before a test for prostate-specific antigen — a blood test that is commonly used in screening, but which can be invalidated by prostate stimulation.
To provide further recommendations for clinicians, much more research on people from sexual and gender minorities is required, Dickstein says. “It’s difficult to offer patients advice,” he says. “I can’t say this is the treatment that you should choose because it’s better for having anal receptive intercourse — I seriously do not know.” Evidence for how different treatment approaches might affect problems such as anodyspareunia, for instance, is lacking.
Research into gay, bisexual and other men who have sex with men has been hampered by small sample sizes, says Rosser. The largest such research sample, collected by Rosser in 2019, included 401 people9. “Cancer registries do not routinely collect data on gender diversity and sexuality,” says Ussher. “We don’t know how many people out there with cancer identify as queer, bisexual, gay or lesbian, or who are trans or have an intersex variation.”
We still have a long way to go, says Rosser — not just in terms of research, but also in educating patients and clinicians on how to communicate with each other about sexual orientation and practices. “This might take a while,” he says. But it is essential that prostate-cancer treatment is tailored to each person’s needs. Equitable care does not mean treating everyone the same, Dowsett says, and any clinician who holds that opinion is wrong. “You can still treat people fairly and equally, but must recognize differences that require different responses.”
Prostate massage is a procedure in which a finger is inserted into the rectum to stimulate the prostate gland either for sexual stimulation or to treat medical conditions such an enlarged prostate, prostatitis (prostate inflammation), erectile dysfunction, and urination hesitancy (difficulty urinating).
This article will discuss the medical and sexual purposes of prostate massage. It also covers how the procedure is done, along with the risks and side effects that may come with it.
Purpose of Prostate Massage
The goal of prostate massage is to release excess seminal fluid—the fluid that mixes with sperm to create semen—from the ducts of the prostate gland. This is thought by some to ease inflammation, promote urination, and relieve symptoms of prostate conditions.1
The prostate gland is located between the bladder and the root of the penis. It produces seminal fluid that nourishes and transports sperm during ejaculation.2 The urethra (the tube through which urine and semen exit the body) runs through the center of the prostate.2
Certain prostate conditions are thought to benefit from prostate massage, including benign prostatic hyperplasia (BPH) and prostatitis.3
Benign Prostatic Hyperplasia (BPH)
BPH is the enlargement of the prostate with age. While the prostate is usually the size of a walnut, for those in their 60s or older, the prostate can reach the size of a plum or even larger. This can cause the compression of the urethra and urinary problems such as:4
For some people, prostatitis can occur spontaneously for no known reason, mainly in older males. Unlike BPH which is progressive, prostatitis can clear (although some people may experience recurrence).5
Some people also regard the prostate gland as the “male G spot.” The prostate, penis, and urethra are all attached to a group of nerves called the prostatic plexus that are activated during orgasm.6
Massaging the prostate gland manually (with a finger) or during anal sex is thought to enhance sexual pleasure.
Evidence of Benefits
The current evidence supporting the therapeutic benefits of prostate massage remain weak and largely subjective.
One study published in the journal Open Urology and Nephrology reported that 115 males with BPH experienced an improvement in symptoms after using a prostate massage device.7
However, the significance of the findings was limited by the lack of a control group, medical tests, or exams of any kind. The researchers instead relied on questionnaires filled out by the participants.
Some contend that prostate massage can treat conditions like erectile dysfunction, which can sometimes arise due to BPH medications. Although prostate massage may enhance the intensity of ejaculation, there is no evidence it can overcome problems like erectile dysfunction.8
Possible Side Effects
The tissues lining the prostate and rectum are delicate and vulnerable to cuts, tears, and abrasions. Massaging the prostate too intensely can easily lead to soreness. In the study described above, for example, 8.3% of participants reported discomfort after a prostate massage.7
Overly aggressive prostate massage can also cause rectal bleeding, creating a risk of bacterial infection or aggravating hemorrhoids.
Furthermore, manual prostate massage is discouraged for males with acute bacterial prostatitis. The massage increases inflammation and may promote the spread of bacteria to the urethra, other parts of the urinary tract, and the bloodstream.9
That said, a few small studies of the effects of prostate massage performed by a physician have shown it to be beneficial as a therapy for chronic prostatitis when paired with antibiotics.10
Contraindications and Risks
Males suspected of having prostate cancer should not be treated with (or engage in) prostate massage, as this may cause tumor cells to break off and spread to nearby tissues.
There’s some evidence that prostate massage, prior to certain tests for prostate cancer, may increase the sensitivity of the test, making it more likely the cancer will be detected.
However, a prostate-specific antigen (PSA) blood test should not be conducted immediately after a prostate massage, as this could lead to false-positive results.11<
Even if cancer is not an issue, it's important to avoid injuring the prostate. The thin, pliable membrane covering the prostate—the prostatic plexus—is full of nerves that serve the sponge-like corpora cavernosa of the penis.
Massaging the prostate too intensely can damage nerves in the corpora cavernosa—two chambers composed of erectile tissue that run the length of the penis. Damage to the corpora cavernosa can result in pain and erectile dysfunction.
How to Prepare for a Prostate Massage
Prostate massage is considered a pleasurable sexual practice by some men. If you try it, to prevent injury or discomfort, you should:
Trim and file fingernails to prevent scratches, cuts, or tears to the rectum or prostate.
Wash and dry hands thoroughly prior to performing prostate massage.
Apply generous amounts of silicone or water-based lubricant (ideally fragrance-free) to help prevent rectal damage or discomfort.
Consider wearing latex or nitrile gloves for added protection.
Before receiving a prostate massage, perform a light douching to remove fecal matter from the rectum.
Never engage in a prostate massage if you or your partner has fissures or hemorrhoids. Doing so can cause bleeding and may increase the risk of infection.
How to Do a Prostate Massage
If performing prostate massage for sexual purposes, it often helps to achieve a state of arousal first. Doing so moves the gland into a slightly upward and backward position as the penis becomes erect.
Apply lube liberally around the anus.
Insert an index finger slowly to the first knuckle and start masturbating.
Pull the finger out and re-apply lube.
As you continue to masturbate, replace your finger back into the anus, this time to the second knuckle.
Repeat steps 3 and 4 until you reach the third knuckle.
Once the finger is fully inserted, search for a rounded lump roughly 4 inches inside the rectum and up towards the root of the penis. This is the prostate.
Gently massage the prostate in a circular or back-and-forth motion using the pad of a finger. You can also apply gentle pressure for seven to 10 seconds, again with the pad of a finger rather than the tip.
Summary
There is very little evidence to support the claims that prostate massage is an effective therapy for prostatitis, enlarged prostate, or other conditions that affect the prostate.
It is clear, however, that prostatic massage comes with risks for males who have bacterial prostatitis, prostate cancer, fissures, or hemorrhoids. For them, prostate massage should be avoided, as it can worsen their condition.
Sleep-sex episodes are rare sleep-related disorders
You’ve heard of talking in your sleep and walking in your sleep. But what about having sex in your sleep? Can that actually happen?
Sexsomnia is a type of sleep disorder known as a parasomnia. You may experience sensations and behaviors while asleep, falling asleep or even waking up with parasomnias. When it comes to sexsomnia, you may engage in masturbation or even engage in sex with others.
Sleep specialist and neurologist Marri Horvat, MD, MS, explains this rare sleep disorder and what to do if you think you have sexsomnia.
What is sexsomnia?
Also known as sleep sex, sexsomnia is when you engage in sexual activity when you’re asleep. And it’s quite likely you don’t know you’re doing it.
In rare cases, some people exhibit sexual behaviors during a deep sleep and have no memory of it, says Dr. Horvat.
“In sexsomnia, the sexual behavior can be outside your normal behavior or it can be your normal sexual behavior,” she explains. “But you’re unaware it’s occurring, and it’s unintentional.”
How does sexsomnia work?
Like sleepwalking, sexsomnia is a parasomnia, a sleep-related disorder that occurs when you’re in between deep, dreamless sleep and wakefulness.
Behaviors during an episode may include fondling, masturbation, sexual intercourse, pelvic thrusting and spontaneous orgasm.
Although you’re asleep, it can appear to others that you’re awake. Someone experiencing an episode might have an open-eyed, vacant look, Dr. Horvat says.
And you may only find out you have the disorder from a partner, roommate or family member.
If someone around you witnesses this unusual behavior, ask them to write down what they observed. Even though it’s embarrassing, their observations can help your doctor diagnose and treat your condition.
Who’s at risk?
Sexsomnia is extremely rare, appearing most frequently in those who have another sleep disorder like sleepwalking.
A study published in the American Academy of Sleep Medicine found that men are three times more likely than women to exhibit sexsomnia symptoms. Behaviors in men are likely more pronounced, perhaps more aggressive. Women are more likely to masturbate.
Other conditions that disrupt deep sleep can also lead to sexsomnia. Heartburn, restless leg syndrome and sleep apnea can all put someone in a sleep-wake state where these sleep-sex behaviors might appear.
Additionally, epilepsy, head injuries, migraines, Crohn’s disease and colitis are also associated with sexsomnia.
What triggers sexsomnia?
Although the reasons behind sexsomnia episodes aren’t clearly understood, many things can trigger them, Dr. Horvat says.
“The obvious triggers are anything that wakes you up,” she says. “Just like making noises, touching or turning on lights can cause someone to sleepwalk when they’re in a deep sleep, you can trigger sexsomnia.”
There’s evidence that drinking alcohol or using recreational drugs may lead to an episode for those who have the disorder.
In many cases, however, the triggers are factors that are more difficult to control, including:
Sleep deprivation.
Stress or anxiety.
Fatigue or irregular sleep patterns.
Some medications like over-the-counter sleep aids.
What sexsomnia treatment options are out there?
It’s possible to manage the disorder by addressing underlying conditions that disrupt sleep, Dr. Horvat notes.
“For treatment, you must avoid any external stimulation that could trigger sexsomnia,” she says. “Both internal and external things that make you uncomfortable or half wake you up can trigger episodes, so you should avoid them.”
Selective serotonin reuptake inhibitors (SSRIs) like Prozac® or Zoloft® to treat depression and anxiety.
Medications for heartburn or restless legs syndrome.
Sleeping in a quiet environment.
But the real key, stresses Dr. Horvat, is to make sure you get enough sleep and maintain healthy sleep hygiene habits.
Protecting those around you
The first step in managing sexsomnia is to get a diagnosis, followed by the appropriate treatment. Speaking to a doctor about these episodes is important.
Because you’re not in control of your actions during episodes of sexsomnia, your condition may put others at risk.
Though you may feel shame about having sexsomnia, talking with your loved ones about it can help them understand and feel safe. Counseling, for you and those affected, may be an option.
While you figure out the best treatment, there are a few things you can do to keep you and others safe:
Sleep in a separate room.
Avoid triggers.
Follow a sleep schedule.
“It’s important to take precautions while you seek treatment to limit any triggers to these events, to help you and those you love sleep safely,” says Dr. Horvat.
Although very few patients are informed about the effects that breast cancer treatments may have on their sexual health, many patients expressed wanting that information throughout all stages of their treatment, according to study findings.
Few patients with breast cancer receive adequate information about the potential effects that treatment may have on their sexual health, according to newly released study results.
The data — which were published in the Annals of Surgical Oncology — also identified that the education patients receive about the effects of breast cancer treatments is insignificant.
The study consisted of a questionnaire as well as interviews and focus groups. In total, 87 patients filled out the questionnaire and 16 patients were interviewed by the investigators.
The patients were mostly younger than 65 (85%), married (67%), White (83%) and heterosexual (98%), but the amount of time since their initial diagnosis varied from less than one year to more than four years.
More than half of the survey respondents reported that they underwent surgery (86%), received chemotherapy (71%) and/or endocrine therapy (66%). Most of the respondents (93%) reported a symptom that negatively affected their sexual health.
The most common symptoms the respondents said they experienced included decreased sexual desire (69%), vaginal dryness (63%) or less energy for sexual activity (62%).
When asked by the investigators about when they would ideally like to receive education on the effects breast cancer treatment has on sexual health, most (73%) said they wanted to be informed of the risks early after their diagnosis.
Most of the respondents noted that their oncology team or health care providers failed to give them any information about the possible sexual health side effects associated with breast cancer treatment.
For patients who received any information, it was more focused on fertility preservation and menopause and not sexual health or pleasure.
“(Patients should) understand that these symptoms and side effects of treatment are incredibly common and that there are ways to mitigate and treat these symptoms,” study author Dr. Sarah Tevis, a breast surgical oncologist at the UCHealth Diane O’Connor Thompson Breast Center in Aurora, Colorado, said in an interview with CURE®.
Tevis urged patients that they should not be afraid to raise the topic of sexual health with their oncology team.
Give Patients Options
The patients in the study suggested that many different educational resources be offered to patients, including the creation of support groups, videos, pamphlets and documents to be distributed at the doctor’s office, and the implementation of routine sexual health questions during their appointments.
One interviewee reported, “I feel that it would be best to have several avenues available. Then you could choose what you feel most comfortable with.”
As a result of the survey responses and subsequent interviews, Tevis noted that the University of Colorado is partnering with the nonprofit organization Catch It In Time to create sexual health videos for both patients with cancer and health care professionals.
“The video series will cover what to expect with breast cancer surgery and how to actively prepare for surgery, managing sexual health symptoms related to breast cancer treatments, and navigating relationships and dating,” Tevis explained. “We hope to have the videos completed by the end of the summer and plan to pilot test the videos in women with breast cancer this fall. If patients find the videos acceptable and appropriate, we plan to make them widely available online.”
She said that there will be four videos in this series with the potential to cover other cancer types and treatments in the future.
A semen allergy, also known as seminal plasma hypersensitivity (SPH), is a rare condition that is caused by a mild or severe allergic reaction to the protein of a man’s semen.1
Research has discovered that semen allergies are more common in women than men, affecting up to 40,000 females in the United States. 1 This is likely because most diagnostic case studies have focused on women. More research is needed to understand how the condition impacts sexual partnerships between males.
While extremely rare, a man can be allergic to his own semen. 2 This newly named condition is called post-orgasmic illness syndrome. 3
Symptoms
Sometimes women experience symptoms with one partner and not another.1 This is because of the unique mixture of proteins, fluids, and other components of a man’s semen.
A semen allergy can cause local reactions minutes or hours after exposure. Most women will see symptoms of contact dermatitis (a red, itchy rash caused by direct contact with an allergen) inside the vaginal canal, externally on the labia, or around the anus. Symptoms of a semen allergy include:
A semen allergy can also cause systemic (body-wide) reactions. Anaphylaxis is a serious allergic reaction that may occur with a semen allergy. 4 Symptoms can appear within minutes after exposure to semen and can be life-threatening. Here’s what to look out for:
A swollen tongue or throat
Wheezing and trouble breathing
Dizziness or fainting
Rapid, weak pulse
A skin rash
Nausea and vomiting
Causes
To understand the cause of a semen allergy, it’s important to note the difference between semen and sperm.
Sperm are reproductive cells containing genetic information used to fertilize an egg. Semen is a composition of seminal fluid from reproductive organs and millions of sperm.
It is widely believed that the major allergen involved in a semen allergy is the proteins produced by the prostate, but other proteins are likely involved. 5 Therefore, it is not a man’s sperm that is the allergen.
Other studies found that medications or food allergens can accumulate in the semen and trigger symptoms in sexual partners with existing sensitization. 6
Diagnosis
The easiest way to diagnose SPH at home is to see if symptoms are prevented with the use of a condom during intercourse. 1
Getting an accurate diagnosis can be challenging because semen allergies are rare.7 Women are often misdiagnosed with:
If you suspect you have a semen allergy, bring it up with your healthcare provider. Ask for a skin or blood allergy test. To do this, your healthcare provider will expose your skin to the suspected allergen, in this case, your partner’s semen, and closely observe for signs of an allergic reaction.
Treatment
Once you and your partner have a diagnosis, you can use one or more of the following treatments to continue a fulfilling sex life free from allergic reactions.
Condoms
First and foremost, condoms can be used during intercourse to prevent skin-to-semen contact. This is the easiest and least invasive treatment method. If you and your partner are trying to get pregnant, there are other methods available (see below).
Desensitization
Desensitization, also referred to as immunotherapy, is a treatment used to expose the immune system to an allergen in an effort to create a tolerance to it. In most cases, immunotherapy can take from three to five years, but the changes can last many years.
Antihistamine
Consider a topical antihistamine cream if you’re experiencing a local allergic reaction. One study recommends Gastrocrom (cromolyn) vaginal cream, which can be prescribed by your healthcare provider. 7
Over-the-counter (OTC) or prescription allergy medication before intercourse may also help to reduce symptoms in severe cases.
It’s important to make a treatment plan with your partner and medical provider that prioritizes the health and well-being of both partners.
Pregnancy and Semen Allergy
The good news is that SPH has not been shown to directly impact fertility. The sperm (and semen) are still healthy. 1
Instead, the challenge lies in having unprotected sex without experiencing symptoms. But today, there are options.
In mild cases, immunotherapy or medication can help eliminate the discomfort of an allergic reaction. People with more severe cases can look into intrauterine insemination (IUI) or in vitro fertilization (IVF). Your partner’s sperm will be washed free of the allergen (protein) and used for insemination.
In either case, talking to your healthcare provider will help you understand the risks, expenses, and results of all options.
Summary
Semen allergy, or seminal plasma hypersensitivity, is an under-researched condition that causes a mild or severe allergic reaction to a specific protein in a man’s semen. Both men and women can be allergic to semen, and experience a range of symptoms from a localized rash to anaphylaxis. Prevention includes the use of condoms, and the use of antihistamines or immunotherapy can be used for treatment.
A Word From Verywell
If you have a semen allergy, remember that your partner’s sperm is not dirty or “bad” and you are not to blame for the way your body reacts to it. Any condition stemming from sexual intimacy is a chance to assess how you and your partner handle challenges together. A semen allergy is not necessarily a sign that you and your partner don’t belong together. Instead, consider it an opportunity to discover other forms of intimacy that can keep you safe and bring you closer together.
As I grew out of playful, teenage sexual relationships that had little drama and joined the world of adult dating – where sex becomes a little more emotional and certainly more complicated – my mum had one piece of advice that she promised was the gospel truth. “The genitals are the brain,” she said solemnly. Well, actually, she said, “dicks are brains and brains are dicks,” but I’m paraphrasing to be gender inclusive. The first time she said this, I thought she was just uttering nonsense. But after I hit my first real struggle with mental health and sex, it clicked into place.
While we’re unlikely to realise it in the moment, poor mental health has a profound impact on our sex lives. Throughout most of my late teens, I struggled to stay present in my body during sex and even developed mild vaginismus (a psychosexual condition where the vagina involuntary contracts, usually due to anxiety). “She just acts up sometimes,” I’d awkwardly joke to one night stands. But I was overlooking the real source. I’d just been through a hard year packed with trauma and leaving it unresolved had left my vagina – and my sexual self in general – dealing with the consquences. Naturally, once I began to work through the traumas that led me there, sex slowly but surely became easier again. It turns out that, as always, mum was right. Genitals truly are the brain.
“While we’ve got a lot better at talking about mental health and normalising those conversations, we’ve still got a long way to go with sex”
DR LAURA VOWELLS
Thankfully, we don’t all have to rely on my mum’s findings to decode the link between the brain and the down-belows. Relationship and sex therapy app Blueheart recently found that 74 per cent of adults struggling with their sex lives say it’s due to stress or a mental health strain, and they’ve done some digging into why that is.
Dr Laura Vowells, one of the founding therapists working at Blueheart, says mental health and sexual desire are “intrinsincally linked”, impacting one another at all times. “While we’ve got a lot better at talking about mental health and normalising those conversations, we’ve still got a long way to go with sex,” she says. “It’s still weird to talk openly about sex problems with friends or family, and there’s still this weird idea that we’re not supposed to be enjoying sex and therefore not supposed to complain about it.”
Adding to the problem, a lot of mainstream mental health services don’t ask about the patient’s sex life when they reach out for support. If a medical professional doesn’t view sexual problems as something worth bringing up, why would a patient? “But they both affect one another. What a lot of people don’t know is that sexual problems are actually more common than mental health problems – we just don’t talk about them,” Vowells explains.
Similar to my situation, 23-year-old Katie struggles with acute, mild vaginismus whenever she’s struggling with her generalised anxiety disorder. “It’s well-managed for the most part, but we all have troughs and my vagina is always the first thing to go. It took me a long time to learn and properly notice that though,” she says. Katie used to “get really upset” when sex was “off the cards” and she couldn’t fathom why. “But now it’s one of those things where I just call it like I see it. I’m like, ‘Oh yeah, I don’t have sex when I’m sad. When I’m happy, I’ll have sex again. That’s cool.’”
The Blueheart survery also found that 31 per cent of respondents were suffering from symptoms associated with more serious sexual dysfunction. This includes arousal and orgasm issues, which range from taking an extended amount of time to become sexually aroused or climax, or experiencing unsatisfying orgasms, to being unable to achieve sexual arousal and climax at all. For those facing more serious sex-related issues, seven out of 10 believed poor mental health or increased stress levels were the cause.
In the UK, more than 51 per cent of women and 42 per cent of men report experiencing sexual dysfunction. And considering that accessing proper sex education is a postcode lottery, the NHS has cut services for sexual dysfunction and didn’t really ever have funding for mental health services in the first place, having these conversations with our loved ones and in public (if you’re comfortable to) is now more important than ever.
When moods and libidos drop, a lot of partners of people struggling with their sex-brains can also suffer with their own insecurities and doubts. Luckily, Vowells has buckets of advice for couples going through this. She tells THE FACE that “it’s really important to talk to your partner about how we feel as it’s happening. As humans, we feel very self conscious around sex. And when a partner withdraws from us sexually, we start to wonder if they’re not interested anymore, or maybe I’m not as attractive anymore. We naturally start to feel rejected and that makes the relationship problems worse.”
So, if you’re going through sexual withdrawal as a result of mental health issues, your partner might need some reassurance. “Part of why a lot of people feel depressed around sex is because they’re worried about letting their partner down,” Vowells explains. Avoiding these conversations will make everyone involved feel worse.
And for the partner on the receiving end? “Try not to take sex withdrawal from your partner personally,” says Vowells. “See how you can help and support them in order for you to get what your partner needs. Don’t do that so you can have sex, genuinely do it for them. Your primary goal should be supporting them to manage their mental health.”
Once you get in touch with your mind and how it impacts sex, you’ll eventually learn to expect sexual changes when mental health challenges arise and figure out how tackle repeitive sexual problems head-on – especially if you talk to a sexologist or therapist
This is something 26-year-old Charlotte* does with her boyfriend. “I withdraw from sex when I’m stressed but my boyfriend wants more sex when he’s stressed. For a while we kept arguing and felt lost, but after three years together, and a lot of trial and error, we expect our sex to be down whenever our mental health is down, and we know we need specific and different things for it,” she says. “You eventually get to that point if you talk enough about it.”
For the time being, Vowells offers this advice: if you’re feeling more anxious, stressed or depressed, ask yourself questions about sex to pinpoint, apprehend (and not overthink) sexual changes. “Ask yourself, ‘OK, am I having sex as much as I was before? Am I thinking about sex the same way? Am I enjoying my sex?’” The answers to these questions can tell us a lot about whether our muddied brains have infiltrated our sex.
It’s easy to feel beaten down when sex problems emerge. We grow up with this idea that sex is easy, as simple as falling asleep or taking a dump. The reality, though, is that sex is complex and we all have specific, individual needs. And when our heads are in the shed, our sexual needs and behaviours are likely to fall away from the familiar. At least now we know our brains and genitals act as one, we can decipher the real meaning behind our sexual problems a little easier and dismantle both stigmas together. Thanks, mum.
Chlamydia infections declined though that may have been due to pandemic-related decreases in screening, rather than an actual drop in cases, the CDC notes.
Overall, rising cases of many STIs—including congenital syphilis—highlight the need for people to be aware of the risks, prevention strategies, and treatment options, says Okeoma Mmeje, M.D., M.P.H., an obstetrician-gynecologist at University of Michigan Health Von Voigtlander Women’s Hospital who has expertise in reproductive infectious diseases.
Who is at risk for STIs?
More than 50% of new STIs in the U.S. are in people aged 15 to 24. Generally, if you’re in this age group and sexually active, it’s recommended that you be screened at least once a year whether that’s at a student health center, a pediatrician or a gynecologist. The CDC also recommends that everyone between the ages of 13 and 64 be screened for HIV at least once.
In Michigan, anyone over the age of 13 can access reproductive services without parental consent, which can help make accessing services easier for young people.
“Testing is important because we know that untreated or recurrent STIs can be associated with reproductive harm, especially in those who have chronic pelvic pain, pelvic inflammatory disease or damage to their fallopian tubes, which increases their risk for ectopic pregnancy or infertility in the future,” says Mmeje.
People should be particularly aware of rising syphilis rates among heterosexual women. In recent years, syphilis hasn’t affected women as much as men. But a change in incidence means women need to know about the risk, including the worrying increase in congenital syphilis.
Congenital syphilis is still relatively rare—there were 2,148 cases in 2020, which amounts to 57.3 cases per 100,000 live births in the U.S. But that’s a staggering increase of 254% over 2016 numbers. And it can be deadly to newborns. Most people can be screened for STIs during pregnancy, so it’s thought the rise in cases is due to a lack of access to prenatal care.
“If someone misses appointments or has no prenatal care at all, that’s where we see these incidents of people falling through the cracks,” Mmeje says.
Preventing and treating STIs
Mmeje wants people to feel empowered and not judged when it comes to STIs. It’s important to have conversations about risks with sexual partners to understand your risk. Barrier methods, like male or female condoms, can help prevent STIs.
If you know you’re at a higher risk for HIV, there are medications you can take to help prevent infection. Risk factors for HIV include multiple sexual partners and intravenous drug use. Other STIs, including chlamydia, gonorrhea, and trichomoniasis, can be associated with an increased risk of HIV infection.
If you do contract an STI, most can be easily treated. In most states, your partner can get medication too without a visit to a health care provider. It’s called expedited partner therapy. A physician can prescribe medication to a person’s sexual partner without doing a separate clinical evaluation.
Mmeje says that clinicians would prefer that sexual partners of a person diagnosed with an STI come in for their own evaluation. But expedited partner therapy can help in cases when it’s not possible for the sexual partner to come in and be seen.
COVID-19 and STI testing
At the beginning of the COVID-19 pandemic, public health resources were redirected to pandemic-related efforts. As a result, STI clinics were shut down and a decrease in sexual health screening and testing followed, according to a study from the National Coalition of STD Directors. People receiving treatment at student health centers may have been particularly impacted.
While this caused many people—particularly those in economically and/or socially marginalized populations—to lose access to these critical health care services, the pandemic forced innovation too.
At-home tests for STIs are more available now than ever before.
“Almost overnight, there were all these platforms available for ordering STI tests online that can be done at home,” Mmeje says.
These home-based tests can be expensive and aren’t covered by insurance. But the privacy and convenience can’t be beat, especially for young people or college students who may not regularly visit a primary care physician or OB-GYN, or for individuals with sexual partners who do not want to seek care in a traditional clinical setting.
Trichomoniasis in women
Most people know about syphilis, gonorrhea, and chlamydia, but trichomoniasis—known as “trich”—isn’t as well known among the general population. But it’s extremely common: there were an estimated 2.6 million cases of it in 2018, according to the CDC. That works out to infections in about 2.1% of women between the ages of 14 and 59.
Trich is a parasitic infection. About 70% of people with it don’t have symptoms. But for those who do, the signs include itching, burning and irritation, discharge from the penis or vaginal area, and discomfort while urinating.
In pregnant people, trich can be associated with early birth or a low birth weight.
Like other common STIs, it’s easily treatable after diagnosis.
Overall, Mmeje wants to reduce stigma around STIs to help more people access STI screening and treatment services.
“I want people to understand and know that an STI is not the end of the world,” says Mmeje. “You can be treated to prevent recurrent infection and complications.”
In a recent survey, more than one-quarter of women ages 50 to 80 said menopause symptoms were interfering with their sex lives — including one-third of those ages 50 to 64.
By Amy Norton
Many women remain sexually active into their 70s, but for others, menopause symptoms and chronic health issues get in the way.
Overall, 43% said they were sexually active, be that intercourse, foreplay and caressing, or masturbation. A similar proportion, however, were limited by health issues.
More than one-quarter of women said menopause symptoms were interfering with their sex lives — including one-third of those ages 50 to 64. Meanwhile, 17% said other health conditions were the problem.
It’s not clear what specific issues were the biggest obstacles. But experts said menopause can affect a woman’s sexual function in a number of ways.
Sometimes it’s relatively straightforward, said Dr. Daniel Morgan, a professor of obstetrics and gynecology at Michigan Medicine.
He pointed to a prime example: The hormonal changes of menopause can cause dryness and irritation of the vagina or the vulvar skin — which can make sex painful.
Fortunately, there are good treatments, Morgan said. For vaginal dryness, women can try over-the-counter lubricants, or get a prescription for vaginal products that contain low doses of estrogen. Steroid ointments can help soothe vulvar skin conditions, Morgan said.
In other cases, sexual dysfunction is more complex.
Declining estrogen levels can directly affect a woman’s libido, said Dr. Stephanie Faubion, medical director of the North American Menopause Society and director of the Mayo Clinic’s Center for Women’s Health.
As a result, women may find their desires are dialed down, and they feel less motivated to initiate sex — though, Faubion said, they may still respond to their partner’s romantic overtures.
At the same time, some women feel exhausted during this time of life, whether that’s related to menopausal night sweats keeping them awake, chronic health conditions, or having a hectic life. Women in their 50s may be caring for kids and aging parents, while balancing that with work.
“If a woman is exhausted, sex drops down the list,” Faubion said.
Mental well-being is also a big factor. Depression can interfere with sexual activity for some women, Faubion said. In the survey, of women who indicated their mental health was poor to fair, only 36% said they were “very satisfied” with their sex lives, versus 65% of women who reported good mental health — though it’s not clear whether the mental health issues caused problems with sexual activity.
When sexual desire and activities do change as a woman ages, that’s not necessarily distressing, both Faubion and Morgan emphasized. It’s only a problem if she is bothered by it, or it’s causing issues in her relationship.
And in cases where a couple is having difficulties they can’t work out, Faubion said, counseling might be the right option.
Menopause-related symptoms were highly prevalent among poll respondents, with half saying they’d suffered one to three in the past year. problems and weight gain were most common, followed by diminished libido, hot flashes/night sweats and mood swings.
Yet, of all women reporting menopause symptoms, only 44% had spoken with a healthcare provider about treatment options.
“Some women may not be aware there are treatments,” Faubion said. “Or they may think the symptoms will be temporary and are waiting them out.”
And, both she and Morgan said, healthcare providers may not be asking about menopause symptoms, or any issues with sexual activity.
But Faubion said it’s important for doctors of all specialties to have sexual health on their radar: Patients with conditions ranging from heart disease to hip replacements are going to have questions about sexual activity, she pointed out.
It is fine for women to let sexual activity go, if that’s what they want: In the poll, 52% of women who were not sexually active said they were satisfied with their sex lives. That was lower, however, than the figure among women who were sexually active, at 74%.
And women who are concerned about their sexual health, or menopause symptoms in general, should feel free to broach the topic with a healthcare provider, Morgan said. Your primary care doctor is a good place to start, he noted.
The poll was conducted online and by phone between January and March and has a margin of error between 2 and 4 percentage points.
More information
The North American Menopause Society has more on sexual health.
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