It’s important to acknowledge that your relationship with sex may change as you go through menopause — it might feel different, or you may experience a loss of sensation, which can make getting sexually aroused more difficult than it used to be. While these changes can be frustrating, they don’t have to become your new normal.
Why Menopause Can Affect How You Experience Sex
The matters of decreased sex drive, lower sexual desire and low libido during menopause is complicated. It’s highly unlikely that a single reason — for example, whether your partner is making an effort to excite you — is to blame. Rather, a whole host of physical, emotional, and sociological forces can play a role, says Stephanie Faubion, MD, MBA, medical director of The North American Menopause Society and medical director of the Mayo Clinic’s Center for Women’s Health.
“Low sex drive can certainly be a symptom of menopause and aging,” says Dr. Suzanne Hall, OBGYN. “But libido in women is based on so many different factors, so seeing hormones as the main cause is largely a misconception.”
It’s important to note the hormonal fluctuations associated with menopause can cause vaginal dryness, which can make sex more painful. Naturally, if you find sex to be uncomfortable or painful, you’ll probably be less interested in it, Dr. Faubion says. She adds that other bodily changes that happen around this time, while not direct results of menopause, can contribute to a decrease in sex drive as well. Weight gain and other signs of aging, for example, can lead to confidence and body image issues in some women, which then fuels a decrease in sexual desire. “In my practice, midlife weight gain, in particular, seems to make some women less comfortable with sex, Dr. Hall adds, “Sometimes women aren’t happy with their bodies. That can cause someone to not feel comfortable in a bedroom situation anymore. It happens a lot.”
Dr. Faubion explains that, as we age, sexual desire during menopause may come second, only after one experiences sexual arousal. In other words, you may find that you feel more interested in sex only after physically engaging with your partner — and that’s perfectly normal.
Beyond that, menopausal women may see their sex lives evolve due to changes in their relationships (say, if their children move out of the house or they go through a divorce) or to outdated, negative socio-cultural messaging around sex and aging women. “Their attentions are directed to a lot of different places at this point in their lives,” Dr. Faubion says. “There’s a lot of complexity to what is menopause-related and what is life stage-related.”
Either way, sexual function and low sexual desire can be a result.
Is a Loss of Sex Drive During Menopause Common?
As mentioned, menopause is much more likely to cause women to experience painful sex than a lack of interest in sex, Dr. Hall explains. “The drivers of libido, hormonally speaking, are androgen hormones [aka male hormones] like testosterone. The general thinking is that they don’t change dramatically in menopause,” she continues. “So, it’s not a given that age or menopause is going to cause a decline in interest in sex.”
But when intercourse hurts, which is often the result of vaginal atrophy and vaginal dryness caused by changing hormones, it’s normal to want to steer clear. “Vaginal dryness can lead to what I call ‘razor blade sex’. And that’s something a lot of women going through menopause can relate to,” Dr. Hall explains. It’s also not unusual for women to be dealing with emotional or body image issues in midlife that affect their sex drive, she adds.
“These are all common phenomena experienced during the menopause transition. And they could be big enough problems that they could lead to a decrease in libido, [contribute to low sexual desire], or change the intimate parts of a woman’s relationship,” says Dr. Hall.
How to Increase Sexual Desire During Menopause
Boosting your sex drive during menopause starts with addressing the root cause, Dr. Hall advises. If the issue stems from vaginal dryness that’s making sex painful, talk with your gynecologist. They’ll be able to discuss your options in terms of both over-the-counter treatments and prescription therapies. And, Dr. Faubion says, the sooner you see them, the better: “Unlike hot flashes and night sweats, which do tend to get better with time, vaginal dryness does not get better with time, and typically can get worse. So, waiting it out is not the right way to go.”
Over-the-counter lubricants are often the first option women try [to improve vaginal dryness], and in some cases, they can be helpful, says Dr. Hall. “I’m a fan of single-ingredient lubricants like coconut oil. Commercial lubricants can have a lot of components to them,” she advises.
When lubricants aren’t enough (and often, they aren’t), non-hormonal therapies that hydrate and revitalize vaginal tissue can be an effective option – particularly for women who want to avoid estrogen-based treatments, says Dr. Hall. “The tissue inside the vagina is estrogen dependent. As we lose estrogen, the tissue becomes less pliable and lubricated, so it tolerates trauma less. And the “trauma” of intercourse is what causes the pain,” she explains.
Hormone-free moisturizing suppositories, such as Revaree®, use ingredients like hyaluronic acid to restore vaginal tissue, improve vaginal health and help make sex comfortable again, Dr. Hall explains. “It’s one of those products I offer to my patients, and recommend they dose two to three times a week,” she says. For best results moisturizers should be used on a consistent basis.
Vaginal estrogen therapy can also be an option. “It has a very different risk profile compared to systemic estrogen therapy,” Dr. Hall says. “There’s minimal to no absorption into the system, so the risk of use is totally different.”
Some women benefit from laser vaginal rejuvenation, a painless laser treatment. “It treats the collagen beneath the vaginal mucosa, making the tissue more pliable,” Dr. Hall explains.
Dr. Hall notes that there’s no one-size-fits-all option for managing or improving vaginal dryness and pain, so it’s important to talk with your healthcare practitioner to figure out the option that’s the best fit for you. “We have treatment options that we can rotate around to individualize what’s most comfortable,” she says.
In addition to your regular healthcare provider, seeing a sex therapist, either by yourself or with your partner, can help improve issues around communication, your perception of aging, and your understanding of how sex can evolve with age, Dr. Faubion recommends. Ideally, seeing both kinds of professionals will allow you to address any physical issues that prevent you from enjoying sex, while challenging foundational and emotional notions that may be undermining your sex drive.
Finally, don’t forget that there’s a difference between sexual arousal and sexual desire. Where the former describes how you physically feel when you want to have sex, the latter refers to your emotional state when you are, quite literally, “in the mood.” Dr. Faubion explains that, as we age, sexual desire may come second, only after one experiences arousal. In other words, you may find that you feel more interested in sex only after physically engaging with your partner — and that’s perfectly normal.
While it’s important to be aware of your changing sex drive and the symptoms that could be contributing to it, loss of libido during menopause is far from a given. “If a sexual relationship is something you enjoy, move forward with it,” Dr. Hall says. “But if you’re having problems with it, let us know. There are treatment options out there that can help.”