A famous New Yorker cartoon depicts a middle age couple walking together. The husband says "Now that the kids are grown and out of the house, do you think we could start having sex again?" While myths and misconceptions abound about menopausal women and libido, supermodel -and super role model- Lauren Hutton says this is a great time for women to explore and enjoy their sexuality. Dr. Donnica Moore, well-known ob-gyn and women's health expert, explains some of the physiologic and psychological issues surrounding menopause and sex. You may be pleasantly surprised!

While menopause marks the end of a woman's reproductive cycle, it does not signal the end of her sexuality. The once popular phrase "finished at fifty" is history. Some women actually feel liberated after menopause when they no longer have to worry about pregnancy or when their child-rearing responsibilities decrease. Yet, for other women, menopause brings about a decrease in sexual interest and activity. While the physical changes associated with menopause may contribute to a decline in sexual activity, it is difficult to say that they are the only factors that may affect sexual activity. Relationship and psychological status play an important role in both sex drive (libido) and sexual satisfaction.

Declining hormone levels are responsible for many physical changes that may lead to a decrease in libido and sexual satisfaction in menopausal women. Without estrogen, the vagina is less well lubricated and the vaginal lining thins. Lower estrogen levels also decrease the blood supply to the vagina and the surrounding nerves making the vagina drier. These symptoms may contribute to painful intercourse.

Other menopausal symptoms that may affect sexual desire include hot flashes, night sweats, insomnia, bladder and urinary tract problems, sleeplessness and fatigue, mood changes, and general irritability. For some women, these changes may translate into a decrease in self-esteem and eventually a loss in sexual desire.

As with any age group, relationship status may also affect sexual activity. Communication is the most important success factor for any relationship. Yet menopausal women may face other relationship issues, especially women without partners. For example, at age 65, women outnumber men by 25 percent. In addition, as men age, the male sex hormone testosterone diminishes causing a decline in their sexual desire and performance capabilities.

In no other arena is the saying "don't worry, be happy" more applicable than in the sexual arena. Many sex therapists find that concerns, worries and fears about sex are usually bigger problems than any physical or sexual changes themselves. Whatever the biological problem, your attitude will be the most important determinant of how well you and your partner cope. At this point in life, the brain remains the most important sexual organ. And common sense goes a long way in resolving sexual issues related to decreased libido or decreased sexual satisfaction.

For example, a healthy lifestyle in general can boost confidence and improve sexual desire. Physical or mental illness may slow sexual response, whatever its cause. As with most conditions, regular exercise, regular sleep, and eating a balanced diet can improve outcomes- as can stopping smoking (it's never too late!) and limiting alcohol intake. Alcohol may help you get "lucky" getting into bed, but it won't help you once you're there!

While truly menopausal women are no longer at risk for unintended pregnancy from unprotected intercourse, a dangerous myth is that menopausal women are no longer at risk for sexually transmitted diseases (STD's). This isn't true. Menopausal women may be less likely to get pelvic inflammatory disease (PID) than younger women, but they are still at risk for virally transmitted STD's such as HIV/AIDS, herpes, genital warts and hepatitis B. Condoms are still recommended for any sexual intercourse outside of a mutually monogamous relationship.

Another prevailing myth about menopause is that it is associated with "empty nest syndrome" and causes depression. Research has shown that the incidence of depression in women actually peaks in the 30's; on the contrary, many women in their 50's experience what Margaret Mead termed "post menopausal zest". Menopause is a risk factor for depression in certain women however, women who have had a previous history of depression (including postpartum depression), women with any other psychiatric illness, women with a family history of menopausal depression, and women with a history of premenstrual dysphoric disorder (PMDD, otherwise known as "PMS"). Depression can also be a symptom of numerous other medical disorders, from hypothyroidism to heart disease to infectious conditions; any menopausal women with depression should consult their physician, rather than assume it's "normal" to become depressed when one enters menopause. What if your doctor's diagnosis is depression? Remember- it is treatable. Depression is not only a major cause of decreased libido and sexual satisfaction, but decreased libido and decreased sexual satisfaction are early symptoms of depression.

Unfortunately, some of the common medicines used to treat depression may also impact your sex drive- or your partner's. Other common medications such as medicines for high blood pressure may have the same effect. Talk with your physician about this; there may be simple changes that can be made which can have very positive outcomes. It's also important-although it may be embarrassing--to talk with your physician about any physical difficulties you may be having related to menopause that may impair your sexual activity. Many of these difficulties can be improved or resolved with medical therapy, such as hormone replacement therapy (HRT), vaginal lubricants, aids for incontinence, or making changes to existing medication regimens.