Ms. Zhang, 56 years old, came to the hospital for consultation mainly because of decreased sexual desire for 5 years and painful intercourse for 4 years. Ms. Zhang has not been interested in sex since she became menopausal at the age of 51 and has been afraid of having sex for the past 4 years because of the significant pain during intercourse. Is it that middle-aged and elderly women are no longer suitable for sexual life? Many women experience a significant decrease in sexual desire and vaginal discharge as they reach middle age. Especially after menopause, they feel that their energy is not as strong as before, and they can’t even get excited about anything, and whenever their husbands want to make out with them, there is a kind of coldness and resentment from inside. Although my husband is very considerate, he still can’t raise his spirits, and because the vagina has become stiff, narrow and dry, it makes sex very difficult and painful. Seeing the disappointed eyes of husbands and remembering the good times between husband and wife, many women are very confused, thinking that their children have grown up and they can have more time to take care of themselves and their husbands, but why they are in this situation? Is it true that women should not have sex after entering menopause? Foreign life reports indicate that more than half of European women over the age of 70 are still interested in sex, and studies show that maintaining a regular, healthy sex life for postmenopausal women is important for physical health, mental well-being, family harmony, and the prevention of genitourinary tract atrophy. And women’s sexual life disorders caused by the degeneration of reproductive organs can be improved by medication. Therefore, postmenopausal women are not unsuitable for sexual life. A few women also experience an increased sexual desire, called the “second honeymoon”. What are the main causes of postmenopausal sexual discomfort? The main reasons for sexual discomfort in menopausal women are physiological and psychological. The physiological causes are the thinning, shrinking and poor elasticity of the vaginal walls due to the decrease in estrogen levels, as well as the decrease in vaginal discharge, vaginal dryness and poor elasticity, which are also causes of painful intercourse. Psychological factors refer to the emotional changes after menopause. As the level of estrogen decreases after menopause, the secretion of other neuroexcitatory substances such as androgens and beta endorphins also decreases, making menopausal women more prone to mental fatigue, emotional depression and decreased sexual desire. Due to the shrinkage of labia majora and labia minora, the distribution of blood vessels is reduced, sexual arousal and arousal are slower, and vaginal lubrication is scarce, so it is easy to interrupt the sexual life of the spouse without sexual interest. In addition, the social and cultural atmosphere plays an important role in sexual behavior. The concept of “sex”, which belongs only to young people, still affects many middle-aged and older women, making them feel embarrassed because of their desire for sex. Therefore, postmenopausal sexual discomfort is a multifactorial syndrome, and treatment by estrogen supplementation alone can only alleviate the patient’s physiological causes, but not completely improve the patient’s psychological causes. Psychosexual characteristics of menopause Menopause is the transition period from adulthood to old age. From the perspective of physiological, psychological and social functions, people at this age are more mature and they shoulder important social and family responsibilities, but the change of sex hormone levels in their bodies and the gradual decline and aging of other physiological functions lead to some characteristics in their psychosexuality. When people reach menopause, they have certain achievements in their career, but they still shoulder heavy responsibilities and suffer more psychological stimuli and blows. As children have grown up and left their parents, the “empty nest syndrome” occurs. However, if they still live with their children, they may have conflicts in their lives due to the “generation gap” and become a source of new stimuli. As women age, many of them no longer hold administrative positions or have retired or retired, and their social roles have changed, adding to their psychological distress and discomfort. In the middle age, they are busy with work and household chores (including raising and disciplining children), and communication between husband and wife may not be enough, and when the children grow up and leave, and both parties retire to spend time together at home, that is, some incompatible or incompatible situation is revealed. Some women believe that menopause marks the end of sexual life, in sex and love is not as enthusiastic as when they were young, reluctant to adapt to the sexual requirements of their husbands, often leading to the deterioration of the couple’s emotional life. Moreover, changes in the family environment and personality (subjective, nagging, easily agitated) can cause marital and family conflicts, and even lead to the breakup of the couple’s relationship. And due to women’s vaginal mucosa atrophy and reduced secretions, it naturally affects their sexual experience and expression. However, there are also women whose sexual experience and expression are not significantly affected in postmenopausal ovarian hypofunction. It has been shown that a woman who has maintained a regular sexual life until menopause can maintain good sexual adaptation after menopause, even after age 60. The negative and pessimistic attitudes women hold about menopause greatly affect their sexual adaptation. They should be clearly told that the onset of menopause is not the end of their sexual life, but rather a way to help them adapt happily and deal with the perceived and practical problems that come with this transition. In menopausal women, the pelvic tissues, neuromuscular system, blood vessels and other organs are gradually changed due to the decrease of estrogen level, and the atrophy of vaginal mucosa increases the chance of local inflammation. Also, menopausal symptoms such as hot flashes, sweating, irritability, anxiety, tension and depression increase the difficulty of sexual adaptation in menopausal women. Men in their 50’s are in the middle of the old and the young (at home) and the top and the bottom (in their career), which is a critical time to build their career. They often invest a lot of energy and physical strength for their careers, and the decline of their physiological functions at this time can easily lead to physical fatigue. As the attention is too devoted to work, coupled with physical fatigue, there may be a degree of sexual indifference. In women, with the decline of ovarian function and changes in the mind, there will also be a fade in sex and lovemaking. These reasons may affect the sexual desire and the coordination of sexual life of menopausal couples. Men age later and more slowly than women. Many men in their 50s have successful careers, social drive and charm, and can become the target of admiration for many younger men of the opposite sex, which in turn increases their sense of superiority. The menopausal women often appear to change in form, such as obesity, inflexibility, old age, loss of the old posture and charm, which will make them have an inferiority complex in front of their husbands, think they are no longer attractive to their husbands, resulting in passive coping in sexual life, and not actively aroused sexual desire. This will affect the harmony of sexual life, and will not reach the climax of sex, and in the long run will make the husband lack of sexual interest and sexual apathy. Therefore, menopause is a special stage for women, husbands should be these temporary physiological changes to women’s discomfort to be understanding and tolerance, to their pain to sympathy and care, which is conducive to them through menopause, but also help family harmony and sexual harmony. The sexual behavior characteristics of menopause Menopause is the process of the gradual cessation of women’s reproductive capacity. Menopause is a sign of the end of reproductive capacity, but it does not indicate the end of women’s sexual demands and responsiveness. On the contrary, when some women realize that they are approaching menopause or are already menopausal, they may also experience an increased sexual desire because they are no longer concerned about their pregnancy. Religious beliefs lead some women to believe that they cannot have children after menopause and that it would be nasty and evil to have sexual demands and desires anymore. Most women, however, do not let the onset of menopause stop their sexual activity or affect their sexual behavior because of the onset of menopausal syndrome. In premenopause, there is the tension of fear of pregnancy shame because of the need to consider contraception. Some women with heavy menstruation and prolonged bleeding may affect their husband’s sexual requirements and interest in sex. After menopause, women experience painful intercourse due to vaginal narrowing and reduced secretions. Some women will take the initiative to seek treatment in order to meet the sexual requirements and sexual harmony of both husband and wife, but some women refuse the sexual requirements of the male partner because of this, which becomes an important cause of emotional discord and family break-up during menopause. Due to the influence of tradition, Chinese women are especially shy to talk about their personal sexual life to outsiders, even if the sexual life is very painful, they have to endure it themselves. Some men lack understanding of women’s sexual requirements and reactions, and even machismo, seeking only to meet their personal desires during sex, not observing, understanding and being considerate to the woman. Long-term sexual inhibition and unsatisfying sexual life can make middle-aged women appear to be bored with sexual life. Intimate marital relationships are often built on the basis of close and harmonious sexual relationships. The significance of a fulfilling marital relationship to both spouses is self-evident, so improving the quality of sexual life is an important issue in stabilizing the marriage of middle-aged couples. How to relieve painful intercourse Painful intercourse is caused by atrophy and dryness of the vagina, so postmenopausal women can use estrogen systemically or locally in the vagina on the recommendation of their doctor to increase the thickness and elasticity of the vaginal epithelium, which can also increase vaginal discharge and reduce or eliminate painful intercourse. Women’s libido is also related to the level of androgens in the body. In western countries, doctors recommend postmenopausal women with low libido to use low doses of androgens along with estrogen, which can enhance libido very well, and choosing the sex hormone tibolone, which has androgenic activity, can improve libido better than estrogen treatment alone.