Is Diminished Sexuality Inevitable During Menopause?
For most people, at least some aspects of sexuality decline with age, such as level of desire or frequency of sexual activity. There are many biologic and non-biologic reasons this happens, including a person’s general well-being and health, lifestyle, as well as interpersonal and psychosocial factors (like the quality of a relationship, or mental health issues).
Contrary to popular misconception, the menopausal transition and resulting drop in estrogen levels does not doom a woman to entering a sexual desert. Women can feel varying degrees of change in sexual function during menopause, but these changes are not absolute, constant, or irreversible. Both men and women experience declining sexual desire and activity with age, and studies show that factors connected to one’s relationship and partner play an important role in levels of desire and the frequency of sexual activity.
Every woman, menopausal or not, has her unique approach to, and expectations about, sexuality. Desire and dysfunction vary from woman to woman. Some menopausal women may not engage in sexual activity due to a lack of desire and, in the absence of partners’ or personal expectations, may pass through menopause without any complaints about sexuality. Others may feel desire but face difficulty in sexual satisfaction due to pain or vaginal dryness. Some women don't experience any changes at all that they associate with menopause.
The longest-running study of women’s experience with aging looked specifically at the issue of changes in sexual functioning, in fact. The Study of Women’s Health Across the Nation (SWAN), which follows women who were between 42 and 52 when the study began, examined the relative contribution of menopause and other factors on changes in sexuality.
In a six-year follow-up of study participants, researchers found that:
- Menopausal women can and do enjoy sexual activity.
- The menopausal transition does not independently cause women’s diminished sexual arousal, reduced sexual activity, and lower levels of physical pleasure, although it can contribute to these issues.
- Vasomotor menopausal symptoms of hot flashes and night sweats are not directly related to sexual functioning. When these menopausal symptoms cause distress and interfere with sleep, however, they can indirectly contribute to psychological factors that affect sexual functioning.
- Vaginal dryness, which is one of the most common symptoms of menopause, can cause vaginal pain and reduced physical pleasure during penetration, which may lead to diminished sexual desire during menopause.
As noted, several factors can affect a person’s experience and sexuality, including:
- General health and well-being: Cardiovascular disease, obesity, joint problems, and urogenital conditions (like urinary incontinence and pelvic surgery) may impact comfort with sexual activity.
- Lifestyle factors: Exercise and a healthy diet protect against conditions such as cardiovascular disease and diabetes that can impact health and sexuality. Several strong research studies have found that being physically active is associated with higher levels of sexual engagement and enjoyment.
- Interpersonal factors: The quality of relationship with a partner, and the partner’s general and sexual health, can contribute to the sexual experiences and satisfaction. The Melbourne Women’s Midlife Health Project (MWMHP) found that relationship factors and prior sexual function and were more important determinants of sexual responsiveness than women’s estrogen levels.
- Psychosocial factors: Women who are depressed or have higher anxiety levels have less optimal sexual functioning. The Women’s Health Initiative’s (WHI) observational study found that — irrespective of the stage of menopause — higher reported levels of social support (like having friends) leads to higher levels of sexual engagement and enjoyment.
There are many factors that can drive changes in sexuality as women age. We advise women not to approach menopause with any preconceived fears of losing their sexuality or ability to experience sexual pleasure. Rather, we encourage women to be aware of the different issues that can affect their lives, including their sexuality, and explore ways to address these changes during and after the menopausal transition.