Decreased libido in menopause

Beginning in perimenopause, some women may experience a gradual decline in sexual desire (libido). However, 60% of women experience no change in libido. Although no correlation has been found between oestrogen levels and libido, it appears that testosterone may also affect libido.

Other factors which could  lead to changes in sexual function include:

• Painful intercourse due to vaginal dryness (atrophy)
• A woman’s perception of her changing body
• Incontinence which could lead to sexual avoidance
• Sleep disturbances due to night sweats
• Depression, stress and anxiety
• Many medications, including some anti-depressants
• Reduced libido and impotence in the male sexual partner

What to do

• Open communication with your sexual partner is very important to prevent resentment or feelings of rejection. It is also important to explore other ways in which you could be intimate.
• If night sweats and insomnia interfere with sexuality, the doctor may prescribe hormone therapy.
• For the relief of vaginal dryness, short-acting, water-based vaginal lubricants such as K-Y jelly can be used immediately before sexual intercourse. Petroleum-based products such as Vaseline should be avoided.
• It may also help to take a warm bath before intercourse. Regular sexual activity can help to improve natural lubrication and can keep the vagina moist and toned.
•  Counselling and support groups can provide useful strategies for coping with lifestyle stresses and poor body image, as well as with physical and emotional symptoms.

Reviewed and updated by Dr Alan Alperstein, obestetrician and gynaecologists in Cape Town, in February 2011. 
Previously partly reviewed by Dr Mike Davey, President of the South African Menopause Society & Dr Tobie de Villiers, gynaecologist and committee member of both the South African Menopause and International Menopause Societies.