Menopause Can Bring Changes in Sexual Response

Q:  I am a menopausal woman who has always had excellent sexual response. For about two years, I have had a cramping sensation in my ovary or fallopian tube, which prevents total orgasm. All tests have come back negative. I have a herniated disk at L3-4 (the low back), which refers its pain to my hip and leg. Would the disc interfere with sexual response? My doctor's next option is laparoscopic surgery, which I would prefer to avoid if it's my back.

A:  In both men and women, the normal sexual response involves an interaction between the brain and nervous system, reproductive hormones and increased blood flow to the genitalia, as occurs with stimulation. But the most important sex organ is the brain: sexual response starts with the brain's reaction to a sexy idea, sight or smell.

Menopausal women may describe a decreased sexual response for a number of reasons. Menopause and estrogen deficiency may cause vaginal dryness; loss of a spouse or a spouse's sexual dysfunction may lessen opportunity for sexual encounters; changes in relationships may lower libido or affect well-being; and concerns about body image might lead to anxieties about sex.

In addition, medications such as anti-depressants or neurological diseases may interfere with the normal sexual response. With so many factors at play, it is often difficult to diagnose the origin of sexual problems. In your case, you have an additional problem: pelvic pain. I suspect your gynecologist is planning laparoscopic surgery, where your uterus, ovaries and fallopian tubes are seen with a camera inserted in very small holes in your abdomen, because she wants to be sure these organs are normal. Some causes of pelvic pain can only be diagnosed in this way.

Although neurological disease can affect sexual function, a herniated disk at the low back usually affects the muscles and nerves of the hip and leg and not sexual organs. Laparoscopic surgery is a reasonable next step, but it’s not guaranteed to give you a complete answer about your changes in sexual response.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.