Sexuality and Perimenopause: What Counselors Need to Know

Perimenopause, which recently has been recognized as separate from menopause, affects approximately 22 million U.S. women. It is a time when women are at greater risk for emotional, relationship, and sexual problems. The authors describe the symptoms of perimenopause, discuss the resulting psychosocial and sexual impact, and present treatment implications for counselors. ********** For women, advancing age and the onset of perimenopause bring a myriad of biological, psychological, emotional, and social changes that place them at higher risk for sexual problems of all kinds (Mansfield, Koch, & Voda, 2000; Myskow, 2002; Palacios, Tobar, & Menendez, 2002). In addition, it appears that perimenopausal women are more tolerant of associated physical changes and are more inclined to seek counseling for emotional symptoms than for physical ones (Dell & Stewart, 2000; Myskow, 2002). As perimenopausal women may be reluctant to complain about or discuss their sexual difficulties, it is helpful for health professionals to be aware of this and ask them about their sexual lives. Sexual problems will thus be identified early at a stage when they are easier to treat. (Myskow, 2002, p. 259) Thus, it is imperative that counselors understand perimenopause, its impact on the lives of those experiencing symptoms, and how to effectively work with these individuals from a systemic perspective. It is hoped that this article will focus the mental health counseling community's attention on the symptoms, impact on sexual functioning, and therapeutic needs of women experiencing perimenopausal symptoms, which are estimated to affect 22 million in the United States (Lange-Collett & Schumann, 2002). Although definitions of perimenopause differ slightly, they all include the salient characteristic of a slowing of the gonadal secretion to a point where a woman transitions from a fertile to a nonfertile state (Banger, 2002; Myskow, 2002). Perimenopause, which recently (i.e., within the past 10 years) has been recognized as separate from menopause, may bring about hormonal changes a decade before symptoms are evident (Lange-Collett & Schumann, 2002). Physiological symptoms include a decrease in size and function of vaginal structures and a decrease in the hormone androgen, which helps stimulate sexual desire in women. These biological changes lead to decreased libido, delay in clitoral response, delayed or absent vaginal lubrication, and decreased congestion in the outer third of the vagina, to name a few changes. Psychological and emotional changes, many of which are attributed to biological changes, include irritability and symptoms of major depression and anxiety (Banger, 2002; Berentsen, Van de Weijer, Van Gend, & Foekema, 2001). In addition, social changes associated with the second half of life are "accompanied by loss--loss of physical capacity, loss of options, and loss of significant others" (Leiblum & Segraves, 1995, p. 692). Other changes in life include empty-nest syndrome, needing to fill a caregiving role for an aging parent, a major illness or death of a spouse, and addressing issues of one's mortality (Morokoff, 1988). In spite of this myriad of changes, women more readily seek assistance for the emotional and psychological symptoms of perimenopause than for the physical symptoms (Dell & Stewart, 2000). The purpose of this article is to describe the physiological and emotional symptoms of perimenopause, discuss its impact on sex and sexuality, and address treatment implications relevant to counselors. PERIMENOPAUSAL SYMPTOMS Perimenopausal symptoms generally occur when women are between the ages of 45 and 55 and last approximately 5 years (Dell & Stewart, 2000). As hormonal levels shift, many women begin to experience hot flashes and night sweats, which are attributed to decreases in estrogen levels. These changes, referred to as vasomotor instability, can result in irritability, insomnia, and related mood disturbances. …