Quote from AStubbs on April 19, 2021, 7:17 pm

Identify a physiological or psychological symptom of one of hormonal related difficulties  (PMS, PMDD, Postpartum Depression, perimenopause, menopause), and describe how it might affect a person and their relationship. Specifically, how might it affect their sexual functioning in terms of desire, arousal, or orgasm. Also, briefly describe how you might you help a couple attempt to cope with this situation.

Quote from malloryoxendine on April 30, 2021, 4:22 pm

When women are experiencing menopause or during their menopausal transition, clinically there are changes to their menstrual cycle and a significant shift in hormones. Menopause brings on many physiological and psychological symptoms primarily because of the hormonal-related difficulties during this time for women. Menopause leads to a decrease in sex hormones to include: estrogen, progesterone, and testosterone. And because of these decreases in these hormones, many women experience hot flashes, sleep disorders, and major depression. From a physiological standpoint, symptoms vary from weight gain, insomnia, fatigue, mood swings, loss of concentration, poor memory, hot flashes, night sweats, vaginal dryness, and urinary stress incontinence; to name a few. All of these physiological symptoms can have a great impact on the psyche of a woman as well, which will go to further affect the individual and the relationship. Out of all of these symptoms, the primary factor that affects sexual satisfaction and functioning is the significant decrease in sex-related hormones, primarily estrogen and testosterone. Studies have shown that 45% of women report a decrease in sexual desire. A woman can also experience vaginal dryness, urine leakage, etc. when having sex which can inhibit desire, arousal, or orgasm. Sexual arousal and orgasm can be met with pain, discontent, frustration, and a detachment or unknown of one’s own body which can affect both arousal and orgasm.

When working with a couple who is navigating through this phase of life, my primary focus would be on broadening their idea of lovemaking. This would begin with normalizing and validating the frustration, physiological changes, and acknowledgment/acceptance of the current stage of life. As that is being done consistently and frequently throughout therapy, I would help the couple broaden their sense and idea of lovemaking. This would look like encouraging other forms of intimacy that may not include typical vaginal penetration. For example, encouraging and teaching intimate touch, relaxation techniques, and helping the couple identify and address what is “successful sex” to them. For the wife, I would coach and encourage group support, self-nurturing, communication, and relaxation techniques to be in touch with her changing body. For the husband, I would coach and encourage open communication, patience, sensual touch on other areas other than the genitals, and education about what menopause means for his spouse on the different levels. Also, I would give education to the couple about the bodily changes, natural remedies, psychopharmacology options, and refer out to an OB doctor for the wife to be addresses any issues that stem strictly from the physiological aspect.  I believe that couples counseling would be the most beneficial when addressing this issue to give the opportunity in the session to not only practice these skills, but discuss fears, worries, and experiences with the couple together.

Quote from Carmon Conover on April 30, 2021, 8:42 pm

When women are experiencing menopause or during their menopausal transition, clinically there are changes to their menstrual cycle and a significant shift in hormones. Menopause brings on many physiological and psychological symptoms primarily because of the hormonal-related difficulties during this time for women.

Mallory, I am so glad you tackled this topic! There are not enough people discussing the effects of menopause or aging on sexuality or on personal well-being. Your suggestion to expand options for lovemaking for aging couples is really important. Aging bodies for both partners means changes that require adjusting expectations and ways of connecting physically.

When I see middle-aged clients, especially women, I always recommend a medical check-up and ask about issues related to menstruation, hormones, etc. Hormones have a huge effect on how we function. I personally have experienced this, as I am now in menopause and had some distressing symptoms when I was pre-menopausal that affected my sleep, my mood, and intimacy. Thankfully, I had access to a world-famous sexual medicine doctor who did labwork that showed my testosterone was in the basement and that I needed help with estrogen and progesterone to balance it, in order to feel better. It worked! A metaphor that helped me realize it was okay to use these resources to improve my life was considering that as I age, wearing glasses or using a hearing aid would not be a problem for me…so why would I question using hormone replacement therapy to improve my body’s ability to function? I now have women’s health provider referrals (they are nurse practioners who specialize in HRT) for my middle-aged female clients.

One resource I found helpful for understanding how HRT works and why it can be a safe option was The Pocket Guide to Bioidentical Hormones by Ricki Pollycove, M.D. I also found helpful a flowchart for treatment decisions in Lisa Moscone’s recent book, The XX Brain.

Quote from meaganturner16 on April 30, 2021, 10:15 pm

It is wise to get medical rule-outs of other conditions before getting pharmacological treatment for PMDD. When working with women, I would likely have them keep a daily log of symptoms in order to best track whether their symptoms point to PMDD and ebb and flow, or whether it could perhaps be something medical or MDD. Psychoeducation with this population and, if relevant, their partners, can be crucial to normalizing PMDD symptoms and to getting the proper medical and mental health treatment needed. Because PMDD is correlated with an increased risk of MDD over the lifetime, it is important to have ongoing dialogue with the client to monitor symptoms.

 

Encouraging basic health in clients can also help naturally improve their PMDD symptoms. In their daily life, this could look like exercising regularly and maintaining a healthy body weight and scheduling lighter days around their luteal phase, can all help keep symptoms to a minimum. Counselors can help by teaching clients ways to manage stress, including CBT techniques and relaxation training, in session so that clients can practice as needed. Taking medication, whether a contraceptive or an SSRI, the two first-line pharmacological interventions for PMDD, both hold risks for sexual functioning. SSRIs inhibit arousal and orgasm, while oral contraceptives decrease sexual desire. So not only will a partnered couple have the female’s irritation, fatigue, and other symptoms, but if she finds the right medication to help mitigate the symptoms of PMDD, she will likely have a more difficult time becoming aroused or simply not feel much sexual desire.

 

I would help a couple cope with this in a variety of ways. First, psychoeducation on how PMDD affects a woman’s body and her options for treatment. Then, I would ask the couple about difficulties they have noticed PMDD has caused them – from communication issues to misunderstandings to sexual functioning. Then we would work collaboratively to come up with the best plan moving forward for both of them. It might mean planning times of sexual intimacy versus times when simple connection and calming might be best.