Dr Philippa Kaye On Menopause and Relationships
Dr Philippa explains how the menopause can affect sex drive, and what you can do to help.
Dr Philippa Kaye
Martha is 48 and did not want to come and see me. She felt slightly ashamed, but her issue was affecting her relationship with her husband.
She told me that until three or four years earlier she and her husband had had an active sex life. Although there were ups and downs, such as when the children were little, they had enjoyed sex. But then her libido dropped and she had no desire at all.
She joked that she really would prefer a bar of chocolate, but she knew that she used to enjoy sex and ideally would like to get back to the way things were.
Libido – what is normal?
Libido means sex drive, your desire for any kind of sexual activity. I am often asked what is normal for your libido, or how often is normal to have sex and the answer is only what is normal for you.
Martha had noticed a difference, a drop in her libido. While her previous levels may have been more or less than average, if there is a difference and it is impacting life and relationships, then it is important to seek advice.
What causes a drop in sex drive?
If only there was an equivalent of the little blue pill (Viagra) used for erectile dysfunction, but libido is extremely complicated and involves physical, social and psychological factors.
Physical factors which can affect libido include hormone levels and at 48, Martha was in the perimenopause. She had other symptoms such as hot flushes and her periods were irregular.
Other physical causes include any chronic health condition and fatigue. Falling levels of testosterone in men as they age can also lead to lower libido.
If sex is painful it is likely to impact on your libido. This may be due to arthritis, or may be due to skin changes in the vagina and vulva.
Genitourinary syndrome of the menopause is common. Lower hormone levels make the skin of the vulva and vagina dryer and less elastic and may lead to painful sex, as well as conditions such as recurrent urinary infections.
What can influence how you are feeling?
Exercise is definitely good for you, with lots of health benefits, but over-exercise can impact on your libido.
Physical health problems may be treated with surgery or other treatments but these may have an impact on your body image and self esteem, which in turn affect libido.
Psychological factors can also have an influence on your sex drive, including stress which impacts most of us at some point. Mental health conditions such as anxiety and depression can lead to low libido.
Medications may also be involved, and medications used to treat mental health conditions can also affect your libido and ability to reach orgasm. Being tired or even just having a bad day can often impact on your sexual desire.
Social factors such as the state of your relationship are also important, as are things like having the time and quiet space to actually have sex, which may be difficult if you have young children or live in a busy household.
In addition all these factors can interact with each other, meaning that often there are multiple reasons contributing to a lower libido.
For example, if on one occasion sex was painful this may lead you to be anxious about having sex again, and this anxiety may lead you to avoid it which may lead to conflict with your partner. And there is a physical, a psychological and a social reason all in one sentence!
Treatment Of Low Libido
Pic: Shutterstock
If you are concerned about your libido then please seek advice from your GP.
The treatment will depend on the cause; they may look at your medication to see if it could be a side effect.
The causes of low libido are too complex to be fixed with a simple pill.
Genitourinary syndrome of the menopause may be treated with lubricants, vaginal moisturisers and topical oestrogen.
Low libido related to menopause may be treated with HRT, which can include testosterone. Other physical causes may have treatments, and treating mental health conditions can improve libido. Psychosexual counselling may also help.
Advice given in this article and on the My Weekly website and magazines is not meant to replace personalised medical advice from your doctor. If you have any health concerns please see your doctor.
Article written on December 15, 2022; article reviewed and updated on October 18, 2024.
Each week we’ll ask Dr Philippa Kaye to talk about a prominent health issue, so look out for more articles in our health and wellbeing section in coming weeks. Read her advice on Cataracts, Heart Attacks in Women, Ulcerative Colitis, Pre-diabetes, Skin Cancer, Allergies, Parkinson’s Disease, Shingles, Ovarian Cancer, Endometriosis, Long Covid and Ticks and Lyme Disease.
Have you heard of menopause cafés?
From awkward symptoms to life-changing advice, Menopause Cafés are helping women break the silence.
It’s a simple concept, hosts organise get-togethers in cafés or workplaces for anyone who wants to discuss the menopause, regardless of age or gender. There are no agendas, guest speakers or products to buy, it’s simply a safe space for those who turn up to start a conversations while enjoying coffee and tea.
Rachel Weiss founded the idea in Perth, Scotland, but there are now menopause cafés around the world. Look for your nearest one here.
