Inspired & Desired: Sex After Menopause
By The North American Menopause Society: The Menopause Guidebook
It’s no secret that once a woman goes through menopause, her sexual desire can decrease drastically. But women don’t need to settle for a life without sex just because they’re over a certain age. The first step towards getting your libido back is understanding why it left in the first place, and there are several culprits.
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, making intercourse uncomfortable. At the same time, the body’s production of androgens (specifically, testosterone) declines with age, which can also decrease desire.
Regardless of when menopause occurs, midlife also comes with a number of social changes that can have a negative impact on a woman’s sex life, such as children leaving home, the need to care for aging or ill parents, or a partner’s “midlife crisis.” Fatigue and stress can also dampen sexual desire. And other contributing factors include changes in body image and self-esteem, as well as concerns about aging and feelings about sex outside of the reproductive context.
Medical problems may also result in low sexual desire. For example, conditions that cause pain, fatigue, or decreased ability to move (such as arthritis) and mental health problems (such as anxiety and depression) can dampen sexual interest and response. Also, certain medications have side effects that may interfere with sexual function, such as antihistamines (used for allergies) that produce drowsiness or drying of mucous membranes, possibly including the vaginal lining. Many medicines used to treat depression interfere with sexual arousal or response.
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. And 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, like 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. Products FDA approved to treat testosterone deficiency in men can be prescribed off-label for women bothered by low sexual desire.
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.