Menopause signals the end of our reproductive capacities, but not the end of our interest in sexual enjoyment. Despite stereotypes that women dry up and become non-sexual after menopause, the reality is often quite different.
Yet many women find that the hormonal changes that begin in perimenopause affect their sexuality. Common complaints include: a lack of, or greatly reduced, sexual interest and desire; problems with mental or physical arousal; less vaginal lubrication; and/or less intense orgasms.
These issues can be affected by perimenopause-related problems such as heavy, unpredictable menstrual periods and mood swings. Hot flashes and night sweats can also dim sexual feelings.
For some women, dryness and thinning of the vagina is the first noticeable and disturbing experience of the menopause transition.
These changes can make sexual activities, especially vaginal penetration, uncomfortable or even painful and can test the resilience of communication with sexual partners. A woman in her early 60s describes her experience:
Vaginal dryness and the resulting pain at intercourse not only hurt, they made me mad. I felt resentment that I was always the one responsible for birth control, with the diaphragm, spermicides, the pill, and then the IUD. Now I was back to stuffing the creams into my vagina for lubrication to have sex I’m hardly in the mood for anymore.
I decided the only way to deal with my anger was to share it with my husband. I showed him all the creams and made him read the warnings on the packages. It turned out my anger was more about the grief I felt at losing my natural lubrication that I had taken for granted all my sexual life. Sharing this with him was transforming. It was like he had joined the planet I was living on, sharing the grief, loss and understanding the risks. I was able to cry and feel much closer to him.
Another woman, who has large fibroids, describes a difficult eight-year menopause transition that started at the age of 46:
During the worst of perimenopause I felt old and unattractive, and I was very bad-tempered and insecure, even anxious. However, now that I am almost completely out the other side of what was basically a whole-organism ordeal, I finally feel very good about myself. I was very dismayed that I developed pretty severe vaginal atrophy right around when my period stopped. This was so bad without estrogen that fairly rapidly it made intercourse completely impossible. Even after the worst of perimenopause was over, I had lost almost all sensitivity in my genitals and so it was hard to become aroused. I persevere, and am able to have orgasms using masturbation, thank goodness, but I was very surprised that my sexuality could change so very much at menopause! No one ever told me to expect all this.
Other women have a much easier time with the transition:
I feel lucky that perimenopause didn’t have a big effect on my sexuality. I was single for a long time, and found my partner only a few years before I began experiencing perimenopause. I desperately wanted our sexual life to thrive. While I have experienced some changes — I don’t get turned on as easily, I don’t experience the overwhelming desire as frequently, and I always need a lubricant for penetration — my attraction and our sexual connection continues to be strong and deeply satisfying.
Another woman adds:
I am 18 years into what I hope will be a lifelong relationship with a woman. Sex for us is a steady friend. During our busy work week, we cuddle, and that’s good. On weekends and on vacations, we make time for lovemaking and cherish how it reconnects and refreshes us.
The underlying cause of sexual changes is not always immediate, making it difficult to know whether the changes are due to menopause, aging, health problems, adverse effects of medication or shifting relationships. See the section on Sexuality and Aging for further discussion.