Not Feeling the Heat? Sex, Libido & Vaginal Dryness—rediscovering yourself

Sex, libido, and vaginal health are common problem areas during perimenopause and menopause and 50% to 80% of women are affected by this.¹ These changes can lead to a decrease in sexual desire , vaginal dryness or discomfort and itching.  This can all have a profound impact on our quality of lives and intimate relationships. 

My libido has dropped through the floor and I’m incredibly angry. AG, UK

In this article, we’ll delve into the key changes in sexual health that can occur during perimenopause, explore the biological shifts behind them, and highlight evidence-based ways to navigate this journey. By understanding these changes, we can embrace this transformative phase as an opportunity to reconnect with ourselves and rediscover our sexuality, paving the way for a fulfilling and positive chapter in our lives.

Let’s go through some of the symptoms

Reduced libido or Sexual Desire: something that can keep us feeling vital and alive –  but the fluctuations or changes in estrogen and testosterone levels during perimenopause can lead to a significant decline in libido. This can manifest as less frequent sexual thoughts, diminished interest in initiating intimacy, or a sense of detachment from sexual activity.

Does sexual desire really need to take a break in perimenopause?

• Vaginal Dryness: Up to 50% of women are also affected by vaginal dryness and we can say that it is also one of the most common symptoms during this transition period. Reduce estrogen level leads to vaginal tissues may feel drier, thinner, or less elastic. This condition, often referred to as vaginal atrophy or genitourinary syndrome of menopause (GSM), can lead to discomfort during sex, itching, or irritation.
• Painful intercourse: No surprise then if the tissues of the vagina are thinner and there is reduced lubrication that sex can be more painful for women at this stage and we enter a negative cycle of further reduced libido. 
• Changes to the big O: Some women experience difficulty achieving orgasm or report that orgasms feel less intense compared to earlier in life.
• Urinary symptoms: Though not directly a sexual symptom, urinary tract infections (UTIs) and increased urinary frequency can also affect sexual confidence and comfort.

Why do these symptoms occur?

Well you probably guessed it, but these symptoms are linked to a decline in our hormones – mainly estrogen and testosterone but also progesterone. 

Estrogen plays a key role in maintaining vaginal health. It keeps the walls thick, elastic and well-lubricated. With it walls thin, and less lubrication means that there can be discomfort down there! The pH balance of the vagina can also change making us more susceptible to infections. 

Testosterone is usually considered a male hormone, but it plays a crucial role for women’s sexual health. It contributes to sexual arousal and overall energy levels. As our ovarian functions decrease, so does our testosterone production and so overall sexual desire.

Progesterone has a less direct role to play – but changes in its levels can contribute to mood swings and fatigue which can impact libido.

Struggling with these symptoms? Here’s how you can manage them.

Hormone options

Is a widely recommended treatment for those symptoms like low libido and vaginal dryness during perimenopause and menopause. 

Vaginal estrogen – Different from hormone replacement, hormone therapy can be localized for example through use of vaginal estrogen cream, vaginal rings, or tablets can restore moisture and elasticity to that area alone. Estrogen is applied directly to your vagina, and by doing that, it helps restore moisture, elasticity, and pH balance, which can reduce pain and irritation. Because you are not taking systemic hormone therapy (e.g. through estrogen gel/tablets or patches), vaginal estrogen has minimal absorption into the bloodstream, making it a localized treatment with fewer risks. 

Testosterone therapy – is used in some countries in a low-dose to improve sexual desire. 

Non-hormone options

Vaginal Lubricants and Moisturizers: Using water-based lubricants is a solution for those who are experiencing vaginal dryness. These types of lubricants can reduce discomfort and using regular vaginal moisturizers can help maintain vaginal moisture. Around 60% of women find sexual satisfaction by using these products. But don’t forget to avoid fragrances and harsh chemicals when selecting a product.²

Lifestyle and Dietary Changes –  Regular exercise and a balanced diet can impact libido and vaginal health.³

Phytoestrogen-rich foods, such as soy and flaxseeds, may provide mild estrogenic effects. Supplements such as maca root, fenugreek and ginseng have been studied for their potential to improve libido, though more research is needed.⁴

Physical activities can increase blood circulation, which have the effect of improving sexual desire. (Faubion et al., 2020). Some of those include pelvic floor exercises that can enhance sexual function and reduce discomfort. Pelvic floor exercises, such as Kegels, or working with a pelvic floor physical therapist may improve symptoms.⁵

Mindfulness and Relaxation Techniques: Up to 30% of women can reduce their anxiety, stress and improve libido with mindfulness practices, such as yoga and meditation.⁶

The value of non-sexual intimacy

Cuddling and hand-holding can help maintain a connection with a partner, reduce the pressure on sexual performance and help restore libido.⁷

Some good sources of further information 

Dr Louise Newsom joins with Samantha Evans to discuss sexual intimacy and libido. In this podcast they take a deep dive into breaking taboos around menopause and sex, understanding vaginal health post-menopause, the importance of proper lubrication and products and exploring other types of intimacy.⁸

Dr Kelly Casperson discussed how menopause can be a time of sexual discovery. Here she discussed common myths surrounding female orgasms, how they impact women’s health, the role of hormones in maintaining sexual desire and much more!⁹

Get the care you need

Perimenopause is not the end of your sexual health journey—it’s a new chapter that invites empowerment and discovery. 

While the physical and emotional changes can feel daunting, you have every right to prioritize your well-being and take charge of your health. 

Your health is worth the attention, the care, and the investment. Many women who experience vaginal dryness admit they are embarrassed to open up about it (53% of women) but talking to your doctor, joining a local support group (or starting a local support group!), or simply talking with friends about your experiences could unlock solutions.

References

1.  Benini, V., Ruffolo, A. F., Casiraghi, A., Degliuomini, R. S., Frigerio, M., Braga, A., … & Salvatore, S. (2022). New innovations for the treatment of vulvovaginal atrophy: an up-to-date review. Medicina, 58(6), 770.
2.  Kennedy, C. E., Yeh, P. T., Li, J., Gonsalves, L., & Narasimhan, M. (2022). Lubricants for the promotion of sexual health and well-being: a systematic review. Sexual and Reproductive Health Matters, 29(3), 2044198.
3.  Crean-Tate, K. K., Faubion, S. S., Pederson, H. J., Vencill, J. A., & Batur, P. (2020). Management of genitourinary syndrome of menopause in female cancer patients: a focus on vaginal hormonal therapy. American journal of obstetrics and gynecology, 222(2), 103-113.
4.  BLACKMAN, J. A. (2018). Midlife and Beyond: Female Hormonal Status/Menopause and Its Effects. Integrative Sexual Health, 28.
5.  Palacios, S., Castelo-Branco, C., Currie, H., Mijatovic, V., Nappi, R. E., Simon, J., & Rees, M. (2015). Update on management of genitourinary syndrome of menopause: a practical guide. Maturitas, 82(3), 308-313.
6.  Kingsberg, S. A., Althof, S., Simon, J. A., Bradford, A., Bitzer, J., Carvalho, J., … & Shifrin, J. L. (2017). Female sexual dysfunction—medical and psychological treatments, committee 14. The journal of sexual medicine, 14(12), 1463-1491.
7. Sala, G., Hooley, J., Hooley, M., & Stokes, M. A. (2024). Comparing physical intimacy and romantic relationships of autistic and non-autistic adults: A qualitative analysis. Journal of Autism and Developmental Disorders, 54(10), 3942-3951.
8.  Sex and the Menopause – Samantha Evans & Dr Louise Newson
9.  Midlife, Menopause, and Rediscovering Sexuality | Dr. Kelly Casperson