Low libido can be attributed to many physical, psychological, and social factors. Emotional and physical health, as well as life experiences, personal or religious beliefs, socialization, and current partnership, all play a role in shaping a woman’s sex drive.
In some ways, menopause is both a physical and psychological factor that can decrease the desire for sex. During menopause, estrogen levels drop dramatically, resulting in a decreased interest in sex. Lower estrogen levels also reduce lubrication causing dry vaginal tissues, which might lead to discomfort or even pain during sex, which can have a rippling effect on sexual desire. Decreased blood flow also affects vaginal lubrication and overall arousal. As a result, a woman may not enjoy sex as much and may have difficulty achieving orgasm.
During the menopause transition, the physical side effects of falling estrogen levels—including hot flashes, night sweats, and vaginal dryness—can undermine sexual motivation and drive. Although not directly related to menopause, the age-related decrease in testosterone may reduce desire in midlife women, as this hormone levels play a role in women’s sex drive and sexual sensation. The precise role of testosterone in desire is complex, however, because low sexual desire in women has not been shown to be related to testosterone levels in scientific studies. Also, some women who undergo abrupt menopause (caused by the removal of both ovaries or by chemotherapy), which leads to an immediate drop in both estrogen and testosterone, suffer a greater reduction in desire than women who experience natural menopause. Interestingly, other women in the same situation do not have a decrease in desire.
A lower estrogen level is not the only culprit behind a decreased libido; there are numerous other factors that may influence a woman’s interest in sexual activity during menopause and after. These include:
- Bladder control problems
- Sleep disturbances
- Depression or anxiety
- Mood swings
- Health concerns
- Relationship issues with a partner
Other symptoms that lead to loss of libido, such as night sweats, do eventually go away for most women. Without the protective effects of hormones such as estrogen, women face an increased risk for heart disease, weight gain, and other new health challenges.
Although many women continue to have and enjoy sexual intercourse in menopause, others find that sex begins to feel like a chore. Menopausal and postmenopausal women may notice that they’re not as easily aroused, and they may be less sensitive to touching and stroking. And while many women and their partners can still enjoy a sense of intimacy without sexual intercourse, other couples struggle to cope with these changes.
Some common conflicts that my patients experience during menopause include:
- Lack of intimate connection with their partner
- Conflict over sexual needs
- Difficulty in communication with their partner about sex
Talking to Your Gynecologist About Intimacy Issues and Menopause
When you come to visit your gynecologist, please know that we care about your emotional and sexual health as much as your physical health. It may feel awkward and uncomfortable to talk to your doctor about your sexual problems, but these types of concerns are perfectly appropriate and we hope to help in any way that we can. You need to be able to openly discuss your concerns with your women’s health doctor.
Please remember, we aren’t here to judge you, and all interactions between patients and doctors are strictly confidential.
What to Ask Your Gynecologist
Here are a few common questions that my patients have found helpful to ask:
- What treatments are available to help with my low sexual desire?
- Can you recommend any books for people in my situation?
- Will my sexual desire ever return to the level it once was?
- Can I make any changes to my daily routine that would improve my condition?
Prepare for your doctor to ask questions about your sexual response and sex life. We may ask about troubles with arousal or orgasm, vaginal dryness, pain or discomfort during sex, and feelings about your changing sex life. Speaking with a healthcare doctor can also rule out any other underlying medical conditions that may cause a reduced libido. These conditions include urinary tract infections, uterine prolapse, endometriosis, or pelvic floor dysfunction.
Educate yourself about your anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and responses. You may also choose to see a therapist who specializes in sexual dysfunction or enhancing sex. Sometimes, couples may want to attend therapy together.
Hormone Therapy for Treating Low Sex Drive
For women experiencing low sex drive as a result of menopause, hormone replacement therapy may help ease the transition. When menopause slows the production of estrogen in the body, hormone replacement therapy works by re-introducing estrogen through a pill, cream, patch, or spray. Hormone therapy can improve mood and help return a woman’s sexual desire and sexual response back to normal levels.
There are downsides to systemic estrogen therapy if you have certain types of endometrial or breast cancers, which are known to respond to estrogen. In these cases, your doctor may advise smaller doses of estrogen delivered directly to the vagina via vaginal creams, tablets, or rings. These can stimulate blood flow to the genitals and aid the vagina in producing natural lubricants, which can help make sex more enjoyable and comfortable.