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Symptoms

WHAT IS IT?

As they enter perimenopause, some women have less interest in sex than they used to. They may have less of a sex drive. Some people call this “lower libido.” Women may have less pleasure and fewer orgasms during sex.

If you are less interested in sex because it is painful, then the first solutions should aim to decrease pain during sex.  Otherwise, the solutions aim to increase pleasure in sex.

WHAT’S HAPPENING TO MY BODY?

Sexual desire decreases with age in both sexes, and low desire is common in women in their 40s and 50s, but not universal. As our nerves and blood vessels age, it may take longer for the nerve signals to work. This happens throughout the body, including in our vaginas. As a result, we may have less feeling, less lubrication, lower arousal, and it may be harder to have an orgasm. Some women have increased interest, while others notice no change at all. What’s important to remember is that there is a full range of psychological, cultural, personal, interpersonal and biological factors that can contribute to declining sexual interest. This may or may not seem like a problem to you.

Read about vaginal pain during sex.

Read about vaginal pain when not having sex.

WHAT TO EXPECT

Sexual desire decreases with age in both sexes, and low desire is common in women in their 40s and 50s, but not universal.

Some women have increased sexual desire post menopause. They report feeling more spontaneous. They no longer have to worry about birth control.

RESEARCH SHOWS THESE TREATMENTS HELP

If a decline in desire is bothering you, tell your healthcare provider. A clinical evaluation can identify any underlying medical or psychological causes of low sexual desire, which then can be treated as appropriate.

  • Vaginal moisturizers and lubricants – helps make sex more pleasurable if the problem is pain during sex
  • Testosterone therapy
  • Ospemifene – helps make sex more pleasurable if the problem is pain during sex. It doesn’t directly affect sex drive/libido.
  • Vaginal DHEA
  • Sildenafil (Viagra) helps with low sexual arousal and problems having an orgasm

TREATMENTS THAT MAY HELP, BUT WE NEED MORE RESEARCH

RESEARCH SHOWS THESE TREATMENTS DO NOT HELP

TREATMENTS THAT MAY DECREASE SEX DRIVE

Sometimes these treatments are given for other menopause symptoms. Unfortunately, your sex drive may suffer as a result.

  Treatments that are inappropriate or have not been studied for this symptom are not listed.

REFERENCES

Kagan R, Kellogg-Spadt S, Parish SJ. Practical Treatment Considerations in the Management of Genitourinary Syndrome of Menopause. Drugs Aging. 2019;36(10):897–908. doi:10.1007/s40266-019-00700-w

Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society Menopause: 2013;20:888-902. DOI: 10.1097/gme.0b013e3182a122c2

Labrie F, Archer DF, Koltun W, et al. Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause. 2018;25(11):1339–1353. doi:10.1097/GME.0000000000001238

Labrie F, Archer DF, Martel C, Vaillancourt M, Montesino M. Combined data of intravaginal prasterone against vulvovaginal atrophy of menopause. Menopause. 2017;24(11):1246–1256. doi:10.1097/GME.0000000000000910

Rahn DD, Carberry C, Sanses TV, et al. Vaginal estrogen for genitourinary syndrome of menopause: a systematic review. Obstet Gynecol. 2014;124(6):1147–1156. doi:10.1097/AOG.0000000000000526

Scheffers CS, Armstrong S, Cantineau AE, Farquhar C, Jordan V. Dehydroepiandrosterone for women in the peri- or postmenopausal phase. Cochrane Database Syst Rev. 2015 Jan 22;1:CD011066. doi: 10.1002/14651858.CD011066.pub2. PMID: 25879093.

Simon JA, Altomare C, Cort S, Jiang W, Pinkerton JV. Overall Safety of Ospemifene in Postmenopausal Women from Placebo-Controlled Phase 2 and 3 Trials. J Womens Health (Larchmt). 2018;27(1):14–23. doi:10.1089/jwh.2017.6385

Tuiten A, van Rooij K, Bloemers J, et al. Efficacy and Safety of On-Demand Use of 2 Treatments Designed for Different Etiologies of Female Sexual Interest/Arousal Disorder: 3 Randomized Clinical Trials. J Sex Med. 2018;15(2):201‐216. doi:10.1016/j.jsxm.2017.11.226

Last updated: April, 2021.

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