The two spheres are closely interconnected<\/strong>. If a person is in good physical and psychological health, they will almost certainly have a better disposition toward sexual activity. At the same time, a satisfying sex life acts as a powerful driver of mood, self-esteem and overall energy. As the World Health Organization (WHO) has also stated, sexual well-being is an integral part of overall health<\/strong>. Menopause<\/strong>, like other life events, for example an illness, disrupts psychophysical and sexual balance: priorities often change, and sex takes a back seat. In these cases, however, it is important to remind patients that sexuality is a fundamental part of overall well-being, and to help them regain<\/strong> it at the pace and in the ways best suited to their situation at the time. <\/p>\n The sexual problems that emerge in menopause can be traced mainly to three broad categories<\/strong>: anatomical, hormonal and psychological. From an anatomical<\/strong> standpoint, the drop in estrogen causes profound changes such as thinning of the mucosa<\/strong>, loss of elasticity<\/strong> of the vagina and reduced lubrication<\/strong>, leading to what we call the genitourinary syndrome of menopause<\/strong>. This often results in dryness<\/strong> and pain<\/strong> during intercourse, factors that naturally dampen desire. The hormonal<\/strong> component, on the other hand, concerns not only estrogens<\/strong> but also the decline in androgens<\/strong> such as testosterone and dehydroepiandrosterone (DHEA), produced partly by the ovaries and partly by the adrenal glands, which directly affect sex drive. Finally, there is the psychological<\/strong> aspect linked to bodily changes: weight gain<\/strong> and the different distribution of body fat<\/strong> can alter self-perception. If a woman no longer perceives herself as desirable, her own desire will inevitably suffer too. Restoring sexuality means acting on all three areas. <\/p>\n Yes, as far as the anatomical area is concerned, for example, we can use hormone therapies that are both systemic \u2014 HRT, which we have already discussed (read the first part of the interview with Dr. Di Pace here<\/a>) \u2014 and topical. Topical hormone therapies<\/strong>, in the form of creams or vaginal suppositories, are one of the most effective and fastest solutions for improving the quality of vaginal tissue and restoring lubrication. It is essential to reassure women that these hormones, acting locally, do not increase the risk of cancer<\/strong>, not even breast cancer. These treatments are often long-term<\/strong>, because if they are stopped, the lack of natural hormones will quickly return the tissues to their previous state. Topical hormone therapy for vaginal atrophy can be successfully integrated<\/strong> into a multimodal approach that also includes physical technologies<\/strong>. <\/p>\n These are “devices<\/strong><\/em>“, equipment that uses physical stimuli to induce tissue regeneration. The vaginal laser<\/strong> is one example: it can be ablative, like the CO2 laser that creates micro-perforations in the mucosa, or non-ablative; in both cases, the aim is to induce a very small, controlled injury that stimulates the production of new collagen and elastin<\/strong>, regenerating the tissue. Radiofrequency<\/strong>, on the other hand, uses electromagnetic waves to raise tissue temperature slightly, producing a remodeling<\/strong> effect and greater tone. Another emerging option is oxygen-ozone therapy<\/strong>, which stimulates the cells of the mucosa through high concentrations of oxygen. These treatments are generally not painful and are well tolerated, and no particular precautions are needed after the procedure, other than abstaining from sexual intercourse that day. Treatment involves cycles of a few sessions, with benefits lasting from 18 to 24 months<\/strong> depending on the individual response. Note, however, that while a hormone treatment can be combined with a physical one, two different devices<\/em> cannot be used in the same period. If appropriate, once a cycle is completed, it is possible to decide with the specialist how to proceed. <\/p>\n Absolutely yes, and it is one of their most important areas of application. For women with a history of hormone-sensitive tumors, for whom there are no conclusive data on the safety of vaginal hormone therapies, physical devices<\/em> represent a valid and safe alternative<\/strong>. The scientific literature of the past ten years has confirmed the efficacy and safety of laser and radiofrequency precisely in these patients, allowing them to treat atrophy without systemic risks<\/strong>. Consider that the first laser for vaginal use was introduced in 2014, and since then studies have multiplied, showing objective improvements in vaginal health parameters and in overall sexual function. <\/p>\n That’s true: the aesthetics of the vulva<\/strong> also change<\/strong> in menopause, for example with loss of volume in the labia majora or thinning of the labia minora, factors that can affect self-perception<\/strong> and the function of the vaginal opening. Today we use techniques borrowed from aesthetic medicine, such as biorevitalization<\/strong> with hyaluronic acid and amino acids, which rejuvenates the dermis and improves its function. There are also vulvar fillers<\/strong>, useful for restoring tone and volume where natural fat has decreased with age. The most advanced frontier, however, is regenerative medicine<\/strong>, which uses stem cells<\/strong> taken from the patient’s own fat, or PRP (platelet-rich plasma), to regenerate tissue affected by conditions such as lichen sclerosus, or for purely aesthetic and functional purposes. While local anesthetics are used for biorevitalization and fillers to reduce discomfort, regenerative medicine techniques require sedation, and recovery after the procedure also calls for greater care. <\/p>\n With menopause (though not only then), the pelvic floor<\/strong> can undergo two opposite types of change: hypertonicity and hypotonicity. Hypertonicity<\/strong> often develops as a reflex response to the pain during intercourse caused by atrophy: the woman feels pain, the muscles contract, and a vicious circle sets in that can also lead to vulvodynia<\/strong> and urination problems<\/strong>. Hypotonicity<\/strong>, by contrast, is linked to the loss of elastic fibers and can cause prolapse<\/strong> or urinary incontinence<\/strong>. In both cases, rehabilitation<\/strong> is essential. The gynecologist’s role is to diagnose the problem, but they usually do not act alone and refer the patient to supporting professionals who, through specific exercises<\/strong>, manual therapy<\/strong> and the correct use of diaphragmatic breathing<\/strong>, teach the woman to regain voluntary control of these muscles, improving both continence and the pleasure of intercourse. There are several professionals to turn to, from midwives to physical therapists and osteopaths, but all must have specific training. The approach differs depending on the professional: a midwife can perform internal manual therapy, a physical therapist works a great deal on breathing, and an osteopath works mainly externally. Devices<\/strong><\/em> can also help with pelvic floor recovery, but while radiofrequency and oxygen-ozone therapy can also be performed by midwives and physical therapists, the vaginal laser remains the domain of the specialized gynecologist. <\/p>\n It is a fact that about 40%<\/strong> of women with sexual problems in menopause do not receive a solution, often because doctors do not ask the right questions or because patients feel embarrassed. For complex problems of desire or sexual function, the ideal would be to see a gynecologist<\/strong> who is also a clinical sexologist<\/strong>. While a traditional gynecologist tends to look only at the physical aspect, a gynecologist-sexologist also assesses the psychological and relational component<\/strong>, which plays a crucial role in female desire. Let us also remember that sexuality involves the couple<\/strong>, and that the male partner may also have age-related problems, and it is therefore important to consider sexual health in terms of shared well-being, turning, if necessary, to a psychologist-sexologist<\/strong> or even to an andrologist<\/strong><\/a>. <\/p>\nWhat are the real physical and psychological causes of the changes in sexuality during menopause?<\/h2>\n
So are there several treatment options available today to address these problems?<\/h2>\n
What is meant by physical technologies for menopause?<\/h2>\n
Some women do not want to take hormones or, like cancer patients, cannot. Are these technologies suitable for them too? <\/h2>\n
Menopause can bring aesthetic changes. The most visible are usually weight gain and fat redistribution, but something also happens at the intimate level. How can this be addressed? <\/h2>\n
Another crucial topic is the pelvic floor. How do pelvic floor problems affect sexual life and everyday health? <\/h1>\n
Women often find it hard to talk about these issues with their doctor. What is your advice on choosing a specialist? <\/h2>\n
To conclude, what key messages and practical advice would you like to leave women with?<\/h2>\n