Libido, vaginal dryness and urinary problems and the menopause

Loss of libido (sex drive) and interest in sex, vaginal dryness and urinary problems can add to the stress and discomfort women feel around the time of the menopause. Women talk about how these symptoms have affected their quality of life, and how they have dealt with them.

Libido (sex drive)
For some women the menopause brings few, if any, changes to their libido or interest in sex. In some cases, freedom from periods and the possibility of getting pregnant can even increase a woman’s sex drive and enjoyment of sex. As one said, ‘If you’re going to ask me was my sex drive affected, no, I enjoyed sex all the time. In fact, no, I think I wanted more as opposed to less’.
Other women, however, said that a loss of interest in sex and reduced sex drive (libido) coincided with other symptoms of the menopause. Women talked about ‘going off sex’; about their libido ‘going out the window completely’. Heavy bleeding, emotional turmoil, hot sweats, and weight gain made some women feel unattractive, uncomfortable and ‘less inclined to feel sexy’.
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Vaginal dryness arising from falling levels of oestrogen can affect libido (see below), and poor health and the pressures of everyday life can leave women feeling exhausted and not ‘as eager’ for sex as before. One woman described sex as just ‘another one of my chores – on my ‘to do’ list’. Relationship difficulties, or changes in sexual performance as a partner ages can also affect women’s feelings about sex (see ‘Relationships, sex and contraception’ and ‘Family, health and life events’).
Treatments are available to help women who worry about their lack of libido and loss of interest in sex. HRT, oestrogen creams and over-the-counter lubricants can ease vaginal dryness (see below). One woman had tried a testosterone implant (tiny pellets inserted under the skin of the abdomen or buttocks which release testosterone into the blood, these are no longer available for commercial reasons) as well as HRT after her hysterectomy to increase her ‘general drive and energy’. It helped some women when a partner adjusted their expectations and found new ways to enjoy sex – and some women enjoyed fulfilled relationships without penetration. In some cases women found it refreshing to move on from the pressures of ‘being sexy’.
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Vaginal dryness
Oestrogen acts as a natural lubricant on the vagina keeping the area moist. As oestrogen levels fall with the menopause, women may notice increased vaginal dryness where the ‘juices don’t flow as much as they used to’. While some women had not been much affected, others found that lack of lubrication reduced their vaginal elasticity. If the vaginal wall had thinned because of low oestrogen levels, sexual intercourse was painful or even impossible. Vaginal dryness can also cause thrush and urinary infections such as cystitis.
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Women who suffer from vaginal dryness found an over-the-counter lubricant helped. They used a lubricant such as KY Jelly, Sylk or Astroglide routinely; others resented having to use a lubricant at all. Sometimes lubricants did not ‘soak into the skin where it was needed’. Lubricants made penetrative sex possible, but had little effect on sex drive. Some women persevered with the discomfort of vaginal dryness rather than use a lubricant.
HRT had helped relieve some women’s vaginal dryness (see ‘Hormone replacement therapy (HRT)’). One woman ‘hangs on to her HRT for dear life’ to avoid problems with dryness. However, another found that after coming off HRT her vaginal dryness returned, making ‘any suggestion of penetration a no no’.
Although they don’t suit all women, prescription oestrogen creams and pessaries can help to restore oestrogen in the vagina and surrounding tissues (these are available in low dose form). Women with severe vaginal dryness also found oestrogen cream helped to ease the discomfort of cervical smear tests.
Urinary problems
Women may also get urinary problems around the menopause. Having to pass water during the night interrupted some people’s sleep and left them tired the next day (see ‘Sleep’). Recurrent urinary infections (e.g. cystitis), urge incontinence (an urgent or sudden need to pass urine) and stress incontinence (passing urine when coughing, sneezing or laughing) can also cause pain and embarrassment. Women don’t know whether or not their urinary problems are caused by the menopause.
Urinary incontinence also tends to happen around the menopause because pelvic floor muscles weaken in middle age, particularly after childbirth. Obesity and other health conditions such as stroke and multiple sclerosis can also cause bladder problems. Pelvic floor exercises helped many. One woman’s recurring bladder infections which kept her off work ‘in agony for a few days’ disappeared after she started taking HRT.
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Women’s lives around the menopause are complex. Falling levels of oestrogen can cause loss of libido, a decreased interest in sex, vaginal dryness and urinary problems, but other biological, psychological and social factors can also play a part. Although distressing, these problems can usually be treated and women should see the GP if they are concerned.

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Last reviewed July 2018.

Last updated December 2012.


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