This article is from "What No One Told You" by Dr. Karen Tang, a board-certified gynecologist whose series is part of Featured Voices, The Washington Post’s partnership with independent creators.
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Do you have zero interest in sex since going through perimenopause or menopause?
It’s very common for women’s libidos to take a major hit in midlife. There are several reasons why low libido happens during this time in your life. First, common symptoms of menopause such as poor sleep, mood changes, and exhaustion can directly impact sexual desire. Low estrogen levels can also cause vaginal dryness and narrowing, making sex painful.
Hormones also affect neurotransmitters in the brain. Specifically, estrogen and testosterone influence levels of dopamine in regions of the brain that mediate sexual desire. Normal levels of both hormones are important for maintaining libido in women, so decreasing levels can suppress it.
Treating low libido in women is complex and goes beyond simply taking hormones, though they can help. I often use the analogy of a car: If the gas tank is empty, you have to fill it, but you also need to make sure the other parts of the car are working well, too. In terms of sex, this means managing mood, stress, sleep, and communication with partners.
If you’re experiencing any pain with sex, treating that pain is essential. This may involve vaginal estrogen, pelvic physical therapy, or addressing other underlying causes. Common causes of pain during sex include:
Vaginal dryness or narrowing
Scar tissue from childbirth
Vaginismus (involuntary muscle spasm)
Tight or dysfunctional pelvic floor muscles
