Inspired & Desired: Sex After Menopause

Adapted from The North American Menopause Society: The Menopause Guidebook

It's no secret that after menopause, a woman's sex life can change drastically, but you don't need to settle for a life without sex just because you are over a certain age. You simply need to understand why your libido is reduced, or why sex hurts, and what you can do to get yourself back to feeling inspired and desired. There are a few reasons you're not wanting as much sex after menopause; let's explore them!

First, hot flashes and night sweats can rob women of restful sleep—and exhaustion never feels sexy. Falling estrogen levels can also lead to vaginal dryness, which can make intercourse uncomfortable. At the same time, the body's production of androgens (specifically, testosterone) is declining, which can also decrease desire.

Menopause often occurs when you are facing a number of social changes, whether it be children leaving home, the need to care for aging or ill parents, or a partner's “midlife crisis.” This can spur fatigue and stress, which do not leave you feeling inspired. Changes in body image and self-esteem can leave you feeling much less desired.

Medical problems may also result in low sexual desire. Some medical issues that may contribute are:

Conditions that cause pain, fatigue, or decreased ability to move; e.g. arthritis
Mental health problems such as anxiety or depression

Medications can also have side effects that decrease your sexual desire. For example:

Antihistamines—used for allergies—that produce drowsiness or drying of mucous membranes, can effect the vaginal lining.
Depression/anxiety medications often interfere with sexual arousal or response

So now you know why your desire for sex after menopause has gone down, but what can you do about it? Often, lifestyle changes, such as exercise, weight loss, or reduced alcohol consumption, will lead to increased sexual satisfaction. Changing or lowering doses of medications associated with sexual problems, especially antidepressants, may be an option.

To spike your sexual interest, try increasing novelty with a weekend away, or introduce sex devices or “toys,” such as a vibrator or dildo, or warming vaginal lubricants, which may enhance sexual pleasure. More attention can be directed to achieving sexual gratification with activities other than intercourse, such as oral sex, manual stimulation, massage, and caressing.

But what if the desire is there, but the sexual function—such as the ability to achieve orgasm—is not? First, discuss this issue with a healthcare provider, who can set you on a course to fix your issues. Referral to a certified sex therapist is often very beneficial and should be considered as an early intervention for almost all sexual problems.

A nonprescription vaginal lubricant or moisturizer, such as Replens Long-Lasting Vaginal Moisturizer, may be sufficient for women with vaginal dryness. As a next step, drug therapy may be necessary. This may include:

Estrogen, either low doses directly applied to the vagina or higher doses taken systemically. Systemic ET affects the whole body, providing relief not only for vaginal dryness, but also for hot flashes and night sweats.
Testosterone. No testosterone therapies are approved in the US to treat female sexual problems, but clinical trials are ongoing.
Dehydroepiandrosterone. DHEA, another androgen, is available without a prescription in the US. DHEA is touted for many health benefits, including improved sex drive. However, there is no evidence it is safe or effective, so its use is not recommended.
Sildenafil. Drugs prescribed for sexual dysfunction in men, such as sildenafil (Viagra and others), have not proven effective in women except for those whose sexual dysfunction is related to antidepressant use.

It's a myth that sex education is only for the young. Sexual function changes with age, and a need for information accompanies these changes. Raising your sexual concerns with a healthcare provider may feel awkward at first, but it's an essential step toward regaining your sexuality.

To purchase the full version of The North American Menopause Society: The Menopause Guidebook, go to menopause.com.

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The Vibrant Voice Ambassador’s mission is to collect interesting stories and useful articles that are relevant for mature women. Our goal is to help you maintain an active lifestyle - to Fifty and Beyond!
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