Not long ago I saw a 52-year-old postmenopausal patient who complained of a loss of sexual desire in addition to mild to moderate vaginal pain during intercourse. Her sexual relationship with her husband had been active and fulfilling when they were in their twenties, when they had sex three to four times a week. In their late thirties and forties, they had sex about twice a week. Now, she told me, they have sex about once every two months, and then only out of strong feelings of guilt.
The patient emphasized to me how understanding her husband was and how gracefully he accepted her deferrals when he approached her for sex. He told her that he understood and didn't want to impose himself on her when she wasn't in the mood. She was taken aback when I asked if she knew whether her husband had any sexual problems. She didn't think he did, but added that she honestly didn't know. She was all wrapped up in her own problems.
The 62-year-old husband then came with his wife to see me. We determined quickly that he had suffered from erectile dysfunction (ED) during the past four years. His condition had deteriorated to the point where he had recently asked his doctor for a prescription for Viagra but hadn't yet mustered the courage to try it. His wife's loss of interest in sex helped him to avoid his problem and seeing whether or not the treatment helped.
This pattern is all too common in couples in which the woman is in her early to mid-50s and the husband is several years older. Her diminishing interest in sex reduces the opportunity for sexual encounters, and this situation is maintained by her spouse's unspoken anxiety about whether or not he will be able to perform. Sex then is usually limited to special situations, like a trip to the islands, when there's a greater hope for or probability of success. Each partner in the couple can then confirm their sexual viability and, when life gets back to normal, continue in their mutual sexual apathy.
As it turned out, my patient was found to suffer from androgen insufficiency, which was almost certainly the basis for her sexual desire disorder. She was treated with a 2 percent percutaneous testosterone gel prepared by a compounding pharmacist. After four to five weeks of treatment she reported significant improvement in her level of sexual desire. Her husband tried Viagra but didn't like the effect it had on his vision, so he switched to another PDE5 inhibitor. He quickly found it very helpful with his ED.