Menopause and Sex

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, Dr. Donnica says this is a great time for women to explore and enjoy their sexuality. In this article, and in the PBS special “Feel Grand with Jane Seymour: Sex Reeducation”, Dr. Donnica explains some of the physiologic and psychologic 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 circumstances contribute to the development of vulvar vaginal atrophy (VVA). These symptoms may contribute to painful intercourse as a result (dyspareunia).

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. For others, they may contribute to feeling exhausted. Both cases may result in a decrease 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. The ready availability of testosterone replacement and drugs to treat erectile dysfunction may have changed that dynamic.