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  • Writer's pictureLila Abbate, PT, DPT, MS, OCS, WCS

Menopause:  It’s Just Not Natural

Updated: Jan 10, 2021

Brangelina’s marital split could have been the course of a relationship; people falling out of love, boredom, wandering eyes, too much drinking and carousing. But what is if the split was really hormonally driven?

Menopause is the natural progression representing finality of the woman’s ability to reproduce. Eggs have disintegrated and no longer dropping so menses no longer occurs. Estrogen and progesterone have over 400 functions within a woman’s body. Normal, cyclical sexual desire that a woman has during her ovulation creates the want and desire to have intercourse – in order to procreate. As we age, that desire diminishes as the hormones lessen over time. For men, the ability to get an erection can also decrease due to the lowered levels of testosterone, but they invented testosterone creams, supplements and Viagra for men, but women have no such cream or pill.

It’s all a complicated process, but in simple terms, testosterone gives all of us sexual desire. Men never have fluctuating hormones. On a light note, we can say men have sexual desire 24/7, usually at any age. Their testosterone may drop due to cardiac conditions (one of the first signs is through erectile dysfunction) or even being sick with the flu, but levels can be recreated through hormonal replacement. For women, testosterone is linked with our levels of estrogen and progesterone and once the levels of estrogen and progesterone diminish, so do levels of testosterone.

So if Angelina, or any breast cancer patient, is whipped into menopause (and we won’t even discuss here the body image and self esteem issues), therefore eradicating levels of estrogen, there are many sexual desire implications that can occur. Sexual desire just relieves - it’s that simple. There are no hormones to sexually wake the person. For some women, when you’re in menopause, you see someone good looking and think they are good looking, but you’d rather read a book. The medical community realizes that women go through menopause, and yes it is a natural event, but unless you are a woman and you can feel and understand what your body is going through, to some it feels like they are alien in their own bodies.

Lack of estrogen to the vaginal tissue is nothing to ignore. From a pelvic physical therapy point of view, lack of estrogen symptoms can vary widely: vaginal burning, vaginal atrophy, urethral burning, urethral “awareness” and pain, urinary urgency, urinary frequency and sexual dysfunction – initial penetration pain, deep thrusting pain or just decreased lubrication which makes the entire event less than fun.

Pelvic floor physical therapy is a way to help women who have pain with intercourse from either natural menopause or artificially induced menopause. Some of my patients have tried using Estrace cream or used Premarin cream often report that those did nothing to help their symptoms. Typically, it is because the muscles have been tight for too long and that the muscles also need to be stretched. If you had a tight muscle in your neck, you would want someone to massage it and stretch it – the same goes for the muscle inside the pelvis. Muscle stretching helps to regain muscle length in order to accommodate for sexual intercourse or improve bladder filling, improve bowel movement frequency. Breast cancer can be terrifying and extra stressful to a relationship when intimacy changes and becomes painful. It can add extra pressure to a solid, loving relationship.

Reasons for vaginal atrophy are many besides menopause. It can also occur due to lack of use – yes, the lack of use. If a patient becomes wheelchair bound, their legs will become tight. The process occurs can be correlated with our pelvic floor muscles. No expansion, no contraction (due to no sexual activity or orgasm) are part of the reason for muscle tightness. What about stress? Stress is also a factor. Some people create tension and holding patterns within their pelvic floor muscles that creates painful intercourse.

Pelvic floor physical therapists at New Dimensions Physical Therapy are here to help! We treat pelvic floor muscles issues in women, men and children and symptoms can vary from person to person. We offer one-on-one physical therapy assessment and treatment in a holistic, well-appointed office.

Please visit our website at for some additional information, or please call to speak to one of our knowledgeable physical therapists at 516-304-5373.

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