Ask the Doctors: Menopause & Sex Drive

My wife has gone through Menopause and is 55 years young, and now has no interest in sex. What can I do?

There are several things that might affect a woman’s sexual interest in mid-life, and I’ll try to lay them out here. To find out which elements are likely to be affecting your wife, you’ll need to talk to her — she herself might not know, and if she’s interested in addressing this, she may need to see a professional. But let’s take a tour of the most common sexual issues of post-menopausal women.

First, her interest may low for physical reasons. Menopause involves hormonal changes, sometimes very substantial ones. (For some women, not so much.) Some women definitely notice that hormonal changes adversely affect both their sexual interest and their orgasm intensity. It’s possible that hormone replacement will make a difference for her, but she’ll need to undergo tests to determine how her levels are to begin with. (If her doctor recommends HRT, she should know many women favor plant-based estrogens rather than traditional Premarin, which is animal-derived.)

Hormones will affect other things besides sex drive; some women like them because they can affect the mental affects of menopause felt by some women, and they tend to slow the effects of age on vaginal tissues and skin. I am not recommending HRT here — for some women, it is ill-advised for health reasons, and others prefer not to take hormone supplements at all. By the way, women do not just have “female” hormones (such as estrogen and progesterone); they also have the “male” hormone, testosterone, and some women have had good luck boosting libido with it.

A partially hormone-related issue that requires no trip to the pharmacy is that some mid-life people have become sedentary and exercise very little. Even if your partner isn’t overweight, if she doesn’t move around much, this hidden libido-killer might have affected her. Try to get her out of the house for walks a couple of times a week, or take the stairs together instead of the elevator when you go out. The body’s hormone production is better when one is active, and it also boosts circulation to the pelvis — healthy blood circulation is what allows one vital part of physical arousal, the engorgement of the genitals.

When one’s ability to become aroused has been compromised, sometimes sex drive wanes right along with it. In fact, if doctors recommended exercise as well as other so-called lifestyle changes, like quitting smoking, drinking too much, and eating fatty foods, the bottom would drop out of the much of the market for drugs like Viagra — and women’s ability to get aroused and interested is not physiologically all that different from men’s.

Since I mentioned pharmaceuticals, I should mention that Viagra, while used by a few women, doesn’t get at libido in people of any gender; but there is a new medication that has just hit the market called Flibanserin that is intended to help women with libido problems. It’s thought that it works on brain chemistry that helps control desire. However, it was tested on women who were younger than your wife, pre-menopausal and without any other possible known  cause of low desire; it is not a fix for everyone, and if anything else in my answer rings a bell for you and your wife, I would recommend following up on that before you consider trying a new and under-tested drug.

Midlife is also a time when latent health problems can begin to emerge, things like heart problems, diabetes, and other fairly-common ailments. One of the earliest warning signs of system-wide illness is a loss of interest in sex. This is also something that can be associated with mental health, especially depression. If your partner has not seen a doctor for a physical lately, it would be advisable for her to do so just to rule this out. She should definitely tell her physician that loss of libido is an issue for her, because some docs will not ask about this unless a patient brings it up. (And if the doctor seems to think she’s fine with no libido, as some conservatively-trained MDs even today might assume — get a new doctor!)

Speaking of health and pharmaceuticals, here’s another possible culprit: If your wife is already on meds for something else, it’s possible that those drugs are actually causing, or at least exacerbating, this issue. Commonly, physicians don’t warn (or sometimes even know) that a drug they’re prescribing will cause such a problem. If your wife is taking antidepressants, there is an especially high likelihood that this undesired dampening of libido is a side effect. She should ask her doc about any meds (and combinations of meds) she might be taking.

Second, there may be psychological factors at play. Some women honestly believe that sex is for the young — in fact, some believe that sex is fundamentally about childbearing and the possibility that sex will result in conception. Whether she thinks she’s too old for it, or she is no longer associating it with the possibility of motherhood, it may be that her mental attitude has always been pre-set to menopause as a time when she would no longer be a sexual woman. Some women also feel less sexual as they age because they feel less attractive. A woman with body-image issues, whether she has gained weight or is upset at finding grey pubic hair, may just have too little comfort when naked to want to have sex. (If this is your wife’s issue, my book Exhibitionism for the Shy is just back on the shelves and may have useful, supportive information for her.)

It’s also pretty common for women to assess everything at midlife, and sometimes this means becoming newly critical of issues in work and relationships that they have not formerly spoken up about or prioritized. I have heard post-menopausal women talk about relationship discontents that range from communication issues to problems with their partners’ physical hygiene or alcohol consumption; this is also a time of life when women sometimes realize they feel taken for granted, or when they allow themselves to be angry about a past infidelity or a relationship that has lost its romance.

I have no idea whether any of these things might be going on for you and your wife — but if they are, you must tackle them positively if you want to rekindle sexual intimacy with her. Sometimes it takes a visit or two to a relationship therapist to unpack such emotional issues. But if such issues are there, they won’t go away without some changes, at least, in your relationship patterns — if only a renewal of your courtship of her so that she feels newly loved, valued, and desired. Some women are just wired this way — they deeply need to feel emotionally secure to have access to their sexual feelings. If you’re in a rut, you can get out of it together — but not if you don’t change some of your patterns.

So if you have not already talked to her directly about all this, it might be a good idea to do so — but you can try courting her anyway (it certainly won’t hurt, and Valentine’s Day IS right around the corner!). If you don’t know what that would entail, she may be able to tell you; but in any event, if she gives you feedback about her needs, take them seriously. (Does this mean you don’t get to have needs of your own? Of course not, and we’re actually addressing one of them now: your need to retain/regain sexual intimacy with your partner. But if your and her needs seem to be mutually exclusive, I’d suggest getting into a therapist’s office and get someone to mediate this discussion for you.)

Finally, it may be that your wife does not think any of this is a problem. She may be content with the level of sexuality in her life and she may not be willing to do anything to change her status vis-a-vis this issue. If so, you have some choices to make. Are the two of you committed to monogamy? Would you be open to discussing the possibility of opening your relationship? There are lots of resources online about polyamory, some good books about it, and support groups that can help you open a relationship. But it’s not for everyone, and some partners deal with a serious sexual desire discrepancy by making sure they have lots of other expressions of love and sensuality in their relationship, and by making sure masturbation is an accepted (in fact, a respected) outlet for the partner whose libido is higher. Bottom line, though, you won’t know what underlies her low interest, or what you might be able to do about it, unless you talk to her. Share this with her, go for a walk, and try to figure out some strategies that might work. Best of luck!

Readers of the GV blog, do you have relevant suggestions? We’re all ears.


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Dr. Carol Queen

Carol Queen has a PhD in sexology; she calls herself a "cultural sexologist" because her earlier academic degree is in sociology: while she addresses individual issues and couple's sexual concerns, her overarching interest is in cultural issues (gender, shame, access to education, etc.). Queen has worked at Good Vibrations, the woman-founded sexuality company based in San Francisco that turned 35 years old in 2012, since 1990. Her current position is Staff Sexologist and Good Vibrations Historian; her roles include representing the company to the press and the public; overseeing educational programming for staff and others; and scripting/hosting a line of sex education videos, the Pleasure-Ed series, for GV’s sister company Good Releasing. She also curates the company's Antique Vibrator Museum. She is also the founding director of the Center for Sex & Culture, a non-profit sex ed and arts center San Francisco, and is a frequent lecturer at colleges, universities, and community-based organizations. Her dozen books include a Lambda Literary Award winner, PoMoSexuals, and Real Live Nude Girl: Chronicles of Sex-Positive Culture, which are used as texts in some college classes. She blogs at the Good Vibes Magazine and at SFGate's City Brights bloggers page and contributes to the Boston Dig. For more about her at

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