We often tend to overlook one aspect of menopause that can cause some very real harm. What are we referring to, you may ask? The pesky problem of low sexual desire. When we talk about desire (or libido, these terms can be used interchangeably), we are referring to your interest or motivation to seek out and engage in sexual activities (1). And while it is absolutely normal for our interest in sex to ebb and flow at various stages, menopause can leave you wondering where it disappeared to entirely. Low sexual desire can seriously impact relationships and your sense of self (2). While it may leave you feeling frustrated, guilty, and even broken, take solace in the fact that these difficulties are amongst some of the most common sexual issues worldwide (3). And most of all, it doesn’t need to be suffered through in silence. So, let’s talk about it. 

If you are struggling with low sexual desire (libido), the following statements may resonate with you:

• “I used to really love sex, what has happened to me?”
• “I am happy in my relationship and love my partner, but I dread the idea of having sex with them”
• “I am so disinterested in sex and that bothers me”
• “I feel so confused and ashamed that I can’t seem to want something that I want to want”

What is the problem at hand? 

First things first, is it actually a low desire problem? You may have assumed this to be the case, but sexual desire is often incredibly misunderstood. So, let’s break it down. Arousal and desire seem to get conflated as the same thing, but these are in fact different. Arousal is the body’s physical response to sexual stimuli. Think of increased blood flow to the genitals, lubrication, raised heart rate/breathing and vaginal tenting. Desire, on the other hand, occurs in the brain. It is when your mind is essentially turned on, and you want sex. 

For some people, their body responds to sexual stimuli and sex feels great, and yet they don’t want to do it again – this is a desire problem. Conversely, if you really want to have sex but when you get started, you can’t get turned on or feel much pleasure – this is an arousal (or orgasm) problem. You could also have both (and neither)! 

Fact: Sex is not a drive needed to survive like thirst, hunger, or sleep. It is not something that we need inherently. So, if you don’t experience an innate need for sex, there is absolutely nothing wrong with you. Sexual desire often requires cultivation and that is okay. 

There is no “normal”. 

Everyone’s inherent levels of desire are different, meaning that there is no “right amount” of sex that you should be having. What matters is that your level of sexual desire works well for you in your life and that you feel satisfied and fulfilled. Some people might be happy having sex once every few days, weeks, or months. While for others, this might be once every few years or even not at all. That is all okay. So, it’s best we drop the comparison of our sex life to that of our neighbours or friends. Low desire is actually only a problem if you feel that it is. Just because you want less sex than others or because your libido has changed does not mean that you are not perfectly normal (4). 

How does age impact sexual desire?

Now, the question we all want to know the answer to…how does age impact desire? Well, we know that sexual functioning does change as we age (4) and that generally, libido does decline. But this is not necessarily an issue for everyone. Many people might have no problem with having less sex. Moreover, wanting less sex does not make you dysfunctional or diseased, you may not even find it bothersome! Remember, your libido is only a problem if you feel that it is. 

Myth: having a low sexual desire means that there is a relationship issue.

Fact: Some people might assume that just because they want less sex, there must be a problem with their relationship. But this is too black and white and simply not always the case. While sexual problems can certainly be an outgrowth of a problem in your relationship, many are not. 

Why might my libido be changing? 

There are several reasons why your sexual desire might change during this life stage, and this varies greatly from person to person. Reclaiming your sexual desire begins with understanding what factors might be at the root of the problem. 

Is it from hormones?  

The cause of low desire is rarely one factor alone, but rather a combination of factors. While fluctuations in hormones may contribute to a lowered libido (2), hormones are not always to blame. Other psychological and social factors such as body image, self-esteem, stress, sexual beliefs, and relationship characteristics are also likely to play an important role (7).

But what about my physical symptoms? 

Up to 80% of women will experience symptoms of genitourinary syndrome of menopause (also known as GUSM…we know, not the catchiest name) which can impact the way you experience your body and sex. 

Some GUSM symptoms include:

Genital symptoms: vaginal dryness, irritation, burning, and itching, changes in discharge and odur, thinning and greying of the pubic hair, pelvic pain and vaginal prolapse (5)  

Sexual symptoms: pain during intercourse, reduced lubrication (even if you feel aroused), bleeding after sex as well as decreased arousal, orgasm and desire. 

Urinary symptoms: Pain during urination, increased urinary urgency, incontinence (leaking urine before you can get to the toilet, recurrent urinary tract infection and urethral or bladder prolapse (5, 6). 

In addition to GUSM, other vasomotor symptoms (like hot flashes, night sweats and sleep disturbances) may also have an impact on your libido (7-10). After all, who would feel like sex with these symptoms...?

What else could be causing my low desire? 

Outside of this, some other factors that may contribute to a low sexual desire can include:

1. Poor sleep 
2. Depression or other mental health concerns 
3. Medication side effects (anti-anxiety, antidepressants, cancer treatments, heart and blood pressure medications, opioid pain relievers can impact libido) 
4. Poor communication with a sexual partner
5. Relationship problems 
6. Past trauma 
7. Stress/exhaustion/lack of time
8. Low self-esteem (I feel “old”, “broken”, unattractive”)
9. Job pressures
10. Family responsibilities
11. Inaccurate or unrealistic beliefs about sexuality and ageing 
12. Other health-related illnesses (such as arthritis, cancer, and hypertension) (11, 12) 

How does sexual desire even work? 

While sexual desire is often approached in absolutely terms, as in you have high or low sexual desire, this misses a lot of the picture. You may be surprised to learn that there are actually two different doorways to sexual desire. 

Door 1: Spontaneous Desire

This involves sexual desire simply appearing spontaneously and out of the blue. It is regarded as a sudden, intense, and immediate desire for sex. It occurs when a mental desire for sex arises before any physical/external stimulus (13). For example, you may be thinking about the last time you had sex with your partner and bang, you feel desire. Research suggests that around 75% of men and only 15% of women report spontaneous desire (14, 15). Spontaneous desire may also fluctuate and decline over time. 

Door 2: Responsive Desire

Door number two is far less spoken about, known as responsive desire. It is the most common form of sexual desire that women experience, and it is just as healthy and normal. It’s when mental interest in sex comes after external/physical stimulus (16). So rather than a sudden urge for sex, responsive desire arises as a response to stimuli such as touch, physical closeness, or sexual contact paired with the right context. For example, you may be receiving a back rub, feeling relaxed and close with a partner which may result in responsive desire. There is absolutely nothing wrong with responsive desire or having a combination of the two. 

What type of sexual desire do you experience? 

You may experience one type or the other, maybe even a combination of the two. Maybe you remember that you used to experience spontaneous desire at the beginning of a relationship, but that this decreased overtime. That doesn’t mean that anything is wrong with you or your relationship! All forms of sexual desire are okay. All valid. Reflect for a moment, what type/s do you experience? 

Let’s normalise responsive desire. 

Responsive desire is how 90% of women and 30% of men experience desire (and unknown numbers of transgender, non-binary and non-gender conforming people), and it is just as healthy and normal (17). It just needs to be accommodated for. But how? Well, it may mean that at least initially, your motivations for sex are less about lust and more about other reasons such as connecting, sharing intimacy, giving pleasure, reducing stress or improving mood (18). Maybe it helps you feel loved, confident, and attractive…the list goes on and on (19). This does not mean having sex out of obligation or when you don’t want to. No, absolutely not. What we mean is being aware of your own reasons for having sex and allowing yourself to be open to it when the moment arises. The way sex educator Emily Nagoski describes it is like going to a party. Sometimes you don’t want to get dressed up and go out, but when you do you have a great time. Often the same goes with sex. So, with that said, what are your motivations for having sex? It is important to recognise that we can’t always rely on spontaneous desire to keep the sexual spark alive!

Does menopause mean the end of sexual intimacy?

Absolutely not! You are never too old to have a fulfilling sex life and while the menopause transition may present its own challenges, it is absolutely possible to navigate these and achieve a pleasurable and satisfying sex life. 

When should I seek help?

If you are persistently experiencing a low libido that bothers you, if you find you can’t get turned on even after you and your sexual partner/s have tried pushing all your buttons or if you don’t experience pleasure during sex, these are not things to ignore. Consider speaking with a sex therapist. 

Bottom line:

Struggles around sexual desire during menopause are common and normal. Acknowledging this can encourage self-compassion and help you move towards making positive shifts within your sex life. 

Zoe Sever is Unfabled's Clinical Lead. Zoe brings a wealth of knowledge from her broad spanning background, having started her career in Nursing and transitioning to Sexology and Research. She holds a Master’s in Sexual and Reproductive Health and is currently pursuing a PhD in Women’s and Reproductive Health at Oxford University. On a mission to empower individuals with cycles to better understand their bodies, Zoe is helping us to banish shame, stigma and demystify reproductive health.

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