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Reclaiming Sexual Health During Menopause: Understanding and Addressing Common Issues

As women age, they are two to three times more likely than men to experience a decrease in sexual desire. Understanding and addressing the factors that contribute to this can help improve sexual health and overall well-being.


The reasons behind decreased libido in menopausal women are complex, involving decreased estrogen production (leading to vaginal dryness and painful sex), body image concerns from menopausal weight gain, and emotional challenges like depression and anxiety caused by symptoms such as hot flashes, brain fog, and lack of sleep.


During menopause, physical effects like hot flashes, night sweats, and vaginal dryness can diminish desire and arousal. Research shows that a fulfilling sexual relationship enhances the overall quality of a relationship, while a poor sexual relationship can have the opposite effect. Women experiencing lower sexual interest and desire often report lower body image, reduced self-confidence, and increased worry about their partner's fidelity.


The sexual response cycle has four phases: desire (libido), arousal (excitement), orgasm, and resolution. People spend varying amounts of time in each phase, and the intensity of these phases can differ. For many women, the order of these phases can vary, unlike the more predictable male cycle. The sexual response cycle can change over a lifetime and even day-to-day. All of these responses are normal.


Treatments for sexual issues depend on the cause(s) and often involve medications, counseling, and self-care. Discuss with your doctor whether medical interventions are appropriate for you. Some options include:


  • Low Libido: Consider switching medications if you're on antidepressants or blood pressure medications known to decrease libido. Testosterone might help, although it's not FDA-approved for low libido.

  • Arousal/Orgasm Difficulties: Some drugs, like PDE-5 inhibitors, might increase blood flow to the clitoris, but more data is needed to confirm their effectiveness. Some of my patients have reported that Aarhousal Cream, a compounded ointment with a combination of medications, helps them with clitoral engorgement and sensitivity.

  • Vaginal Dryness/Atrophy/Pain during Sex (Genitourinary Syndrome of Menopause (GSM)): Choosing the right therapy depends on the severity of symptoms, the effectiveness and safety of treatments, and patient preference. Check out this post for more details about treating GSM.


Much research is still needed to fully address women's sexual health, but there are many options available now. Don't let anyone tell you that diminished sexual pleasure is just part of aging. Sex is important and possible at all ages.



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