The Impact of Menopause on Sex

The onset of menopause can significantly impact a woman’s sexual life, but there is hope!

If you or your partner are experiencing a decrease in sexual desire during menopause, you’ve come to the right place. In the following paragraphs, we will discuss the effects of menopause on a woman’s sex drive and provide advice on how to navigate these changes.

Menopause Statistics

Menopause can bring about symptoms such as hot flashes, night sweats, headaches, and mood swings. Even if you manage to avoid these, it doesn’t mean you won’t face sexual challenges. A survey of over 2,500 women reported by the British Telegraph revealed that more than 80% expressed a desire to maintain an active sex life, despite feeling let down by their bodies. Similarly, a study by Philip M Sarrel, MD, found that 77% of women experienced a loss of sexual desire, 50% had sex less than once a month, and 24% experienced pain during intercourse.

Unfortunately, these difficulties can arise even for women who have previously enjoyed a satisfying sex life.

Understanding Menopausal Symptoms

Menopausal symptoms do not manifest suddenly; they develop gradually due to a decrease in estrogen and an increase in FSH (follicle stimulating hormone). By the age of 40, testosterone levels, responsible for female sex drive, are typically half of what they were at 21. In the first two years of menopause, there is a further 15% reduction in testosterone levels.

These changes lead to decreased vaginal lubrication and dryness during sexual arousal, reduced clitoral sensation, and vaginal muscle relaxation. Achieving orgasm may also become more challenging.

The physiological problem arises from reduced blood flow to the clitoris and vagina. Low estrogen production in the ovaries causes changes in vaginal tissue, resulting in decreased elasticity, a narrower vaginal opening, and more delicate tissues, leading to pain during intercourse. Additionally, longer stimulation may be required to achieve lubrication.

Psychological changes also play a role, as some women may anticipate pain during sex and develop vaginismus, an involuntary contraction of vaginal muscles that prevents penetration.

These changes can also affect partners, as some men may experience erectile dysfunction due to difficulties with penetration. This can lead to sexual performance anxiety for the partner.

What Can You Do About It?

Addressing sexual functioning during menopause can involve hormone therapy, but it’s generally not recommended to continue hormone use for more than 10 years due to the increased risk of breast cancer.

Hormones can be administered in various forms such as tablets, skin-applied gels, patches, or local creams, tablets, or ointments for vaginal treatment. These treatments have been reported to improve sexual functioning for approximately 80% of women, resolving issues of pain during intercourse. Surveys indicate that these treatments restored clitoral sensitivity for 55% of women, 30% regained the ability to have an orgasm, and 40% experienced better orgasms.

However, even if vaginal dryness and pain are alleviated, some women may still experience a loss of sex drive. In such cases, adding a low dose of testosterone with close monitoring is recommended by some. Research suggests that daily application of testosterone to the skin leads to a two- to threefold increase in the need for sex. Additionally, a combination of testosterone and estrogen has been shown to be more effective in improving sexual desire compared to hormonal treatment that does not include testosterone.

It’s important to note that some women may experience side effects from testosterone, such as excessive hair growth and changes in voice, particularly among smokers. However, these side effects are not common and can be minimized by carefully adjusting and monitoring the dosage. In most cases, excessive hair growth disappears upon discontinuation of treatment.

In summary, many women can use estrogen and testosterone during menopause to address sexual dysfunction with positive results and minimal side effects. Consult with your doctor to explore the various treatment options available.

Dr. Zvi Zuckerman is a medical doctor and certified sex therapist. Dr. Zuckerman was certified as a supervisor of sex therapy by the American Association of Sex Educators, Counselors and Therapists (AASECT) and as a marital and sex therapist by the Marriage Council of Philadelphia at the University of Pennsylvania. Dr. Zuckerman is a consultant of the Between Us Clinic, which provides the PE Program—an online home exercise program for treating premature ejaculation.