Our golden-years sex life is a little rusty

Q: My wife and I are in our golden years, but our sex life is no longer golden because my wife has lost interest. How can we get things back on track?

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A: One reason your wife may be avoiding sex is that it hurts. After menopause, women may develop vaginal thinning and dryness so that intercourse becomes uncomfortable.

Using an over-the-counter lubricant can help, but if that doesn’t suffice, your wife should talk to her gynecologist about getting a prescription for vaginal estrogen. When used “locally,” estrogen can help restore the thickness, blood supply and lubrication of the vaginal lining.

Vaginal estrogen comes in three forms: creams (Premarin, Estrace or generic estrogen cream), tablets (Vagifem) that are taken twice a week, or a ring (Estring). The ring looks like a hollow diaphragm and is self-inserted into the vagina where it secretes small doses of estrogen over three months.

But even if intercourse is comfortable (and pleasurable!), libido can be low. This may be due to a decrease in testosterone production with age.

(If your wife is on hormone-replacement therapy, especially in pill form, there is another libido twist. The estrogen she is taking can increase levels of a protein that binds up testosterone, rendering it less potent and less likely to elevate desire. Her doctor can test her level of free testosterone with a blood test and, if it is low, add testosterone.)

For women wishing to boost their desire by boosting their level of testosterone, there are several ways to deliver it:

• Estratest is an FDA-approved form of estrogen combined with testosterone in one pill.
• There are also creams, lozenges or drops of “just” testosterone (the latter two are placed under the tongue for sublingual absorption). Currently, these are not FDA-approved and must be made by a compounding pharmacy with a doctor’s prescription.
• A testosterone patch for women is in the pipeline and should be approved by the FDA in a year or two.

But testosterone is not for every woman. Too much of this male hormone can cause acne, oily skin and excessive hair growth. Women with liver abnormalities, high cholesterol or a substantial risk for heart disease should not use it.

Having given you all this information on hormones, I must add a disclaimer. Hormonal therapy is not the final word in libido therapy.

Lack of desire can also stem from depression, anxiety, chronic disease, antidepressants or heart medications.

In addition, though I assume from your question that your marriage is otherwise happy, lack of desire can often stem from relationship problems.

Dr. Reichman’s Bottom Line: The golden age can be tarnished by a lack of pleasurable sexual intimacy. The conversation between you and your wife might be as important as the one between your wife and her doctor.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You willl find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of HarperCollins.