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Menopause

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’.

 

Barbara’s libido may have dropped a little but she doubts the menopause is to blame

Barbara’s libido may have dropped a little but she doubts the menopause is to blame

Age at interview: 52
Sex: Female
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Any change in libido over the menopausal time?

Yes I think there has been. But again I don’t know if that’s after the throes of first romance or whether it’s just an age thing or whether it’s a menopause thing. I mean we still both get worked up but not as often and sex isn’t as important. Is that an age thing or is that a menopause thing? I don’t know. You talk to a lot women and they say, “Oh, I haven’t had sex for a long time, don’t want sex”. And I think that’s weird. It’s never stopped me with sex.

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’.
 

Jill has lost interest in sex despite loving her husband ‘to bits’

Jill has lost interest in sex despite loving her husband ‘to bits’

Age at interview: 47
Sex: Female
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Now women talk about other effects of the menopause, other symptoms like loss of libido, vaginal dryness those sorts of things. Have you noticed any changes with that?

Yes. I’ve lost interest totally in sex. I love my husband to bits I adore him, I love a kiss and a cuddle. That means more to me at the moment but I’m just not interested but that’s not to say that I don’t love my husband because I do very much. And he knows that.

And it’s not important to me at all because I show my husband I love him in other ways and I don’t mind a kiss and a cuddle.

And he’s very understanding and he knows it’ll pass.

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’).
 

Deborah and her husband are going through a rough patch but they’re ‘muddling through’

Deborah and her husband are going through a rough patch but they’re ‘muddling through’

Age at interview: 48
Sex: Female
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And your sex life, did it [menopause symptoms] affect that?

Well that’s been up and down because of his issues as well anyway really. So we’re kind of muddling through and I think he understands.

I feel like my libido has gone off a bit but we’ve been together for years, so we’ve been through ups and downs, and at the moment it feels like we can, no not always, sometimes it feels pretty, pretty difficult, but I remember I think I heard this on the radio, somebody talking about intimacy, and it was probably like a marriage guidance person or something like that and they were saying that intimacy is not just intercourse, and I think I’ve hung onto that, and sometimes it’s about actually sharing personal private things and so at least you feel close.

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’.
 

Mary has become a ‘wise old woman’, too busy to worry about her lack of libido

Mary has become a ‘wise old woman’, too busy to worry about her lack of libido

Age at interview: 57
Sex: Female
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I have no libido, I have no sex drive at all and I have no interest in sex which is probably quite a good thing because nor has my husband. And aren’t hugs lovely and you do learn the benefits of a friendship and a physical closeness which is not a sexual relationship and maybe I miss it a bit but on the whole I don’t really think about it because I’m really too busy.

Well, it’s funny I mean it’s actually now I feel as if I’ve joined the wise old women’s group which is another very positive image, I look around myself at church and I look around myself at family parties and work arrangements and I look around and I think “yeah, I’m a wise woman now, I’ve joined the wise women”. I’ve got a secret, I know. You don’t. And that makes me feel great, because I’m no longer looking in a room and thinking who can I pull, phew, I wonder what he’d, phoow I’d like to know what he’d look like with no clothes on. I don’t do that anymore. That’s lucky because I’m not going to.

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.
 

Sharon’s lack of lubrication is putting her off sex

Sharon’s lack of lubrication is putting her off sex

Age at interview: 51
Sex: Female
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You mentioned that sexually there’s problems with vaginal dryness?

Oh yeah.

Can you talk a little bit more about that?

The dryness, alright, okay. I’m not a big person but I mean I’ve been with the same man for many years so we know intimately each other’s bodies. But when you can’t, for a start you don’t feel sexual. I don’t feel sexual because I’m like nearly ten stone, I don’t feel attractive anymore because of my size and together with that then I’m not lubricating. There’s nothing happening down there and I mean obviously that does cause arguments between a couple because I mean the sex is very important in a marriage and yet when you’re sort of saying “No, no, no, no” night after night after night after night and it’s not because it’s anything to do with that person, it’s you. And it does, because you just can’t get any whatever it is lubrication yourself. And then you go on to using a jelly or something but it’s not the same then because you’re like, “Why am I having to use this”. I’ve never used this in twenty odd years and I’ve got to use it because this fucking thing’s happening to me. And it does cause problems yes. I mean we’re alright but it’s not a good time for any relationship and I reckon if you can get through this within your relationship then you’re on to a winner.

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.
 

Carole says she’s a bit ‘old fashioned’ and prefers not to use a lubricant despite vaginal dryness

Carole says she’s a bit ‘old fashioned’ and prefers not to use a lubricant despite vaginal dryness

Age at interview: 51
Sex: Female
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Vaginal dryness, yes, it’s always well I say it’s always been there, it’s always been a problem and I would definitely say there was one particular HRT which helped better than the others and I can’t remember the name of it. I think it might have been Premarin, I remember saying to my husband “Ohhh HRT’s working” or working better. Yeah it is quite dry.

When you say it’s always been a problem you mean during the menopausal transition?

Yeah, yeah.

And what do you do about it?

Nothing, just persevere.

So you don’t...

We don’t...

...use lubricants or anything like that?

No, we talked about it but I’m a bit old fashioned, a bit naive on things like that. We just keep plodding on and if it hurts too much then we don’t do it. We try again later. And it’s quite funny because it does take sometimes two or three goes in a night, an evening or whenever we do it. Sometimes we have to give up. My husband says, “This just isn’t going to work” and there’ve been a few tears over that but we get by it.

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’.
 

Jane has used Vagifem, a vaginal pessary, to stop her vaginal wall tearing during sex

Jane has used Vagifem, a vaginal pessary, to stop her vaginal wall tearing during sex

Age at interview: 64
Sex: Female
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There’s only one other thing that you might be interested in is that I didn’t know that HRT didn’t prevent thinning of the vaginal wall. I assumed that since I was on HRT that would protect me from vaginal problems as well and not so long ago I felt that the vaginal wall was thinning a bit because sometimes during sex I tore a little bit. So I discussed that with my GP and she’s suggested something else called Vagifem, which is a tiny, tiny pessary, smaller than a pea which you just insert I think it’s once a day for the first week and then twice a week and that’s already improved matters after only a couple of weeks.

And the GP said that actually a consultant that she knew said that all women over the age of menopause should be told about this and that a lot of women are probably suffering in silence not knowing that this can occur.

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.
 

Rhonda was prescribed an oestrogen cream to use before her cervical smear because of vaginal dryness

Rhonda was prescribed an oestrogen cream to use before her cervical smear because of vaginal dryness

Age at interview: 46
Sex: Female
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And again it’s something you don’t always feel comfortable talking about and I have a female doctor who’s absolutely fantastic. From a sexual intercourse point of view over the years that has become very painful for me but I have gone back to the doctor and there are things you can have. But one of the issues I have is because I still have my cervix, so when I have to have my smears every three years, and what happened after the first three years after my diagnosis and going through the menopausal symptoms, I found my smear was absolutely uncomfortable, it was very very uncomfortable indeed. But what I had to do before that was that I was given an oestrogen cream to use internally because otherwise they couldn’t get a correct reading from the cervix.

So when did you apply that, was that just before you had the smear?

A month before.

You had to use it for a month?

Yeah, every day for two weeks and then for two weeks every other day. And then that was it and then I had the smear, then not use it again.

 

Since having breast cancer treatment Margaret can no longer use oestrogen cream to relieve her...

Since having breast cancer treatment Margaret can no longer use oestrogen cream to relieve her...

Age at interview: 59
Sex: Female
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Yes, I think there was a combination of factors but certainly extreme discomfort and vaginal dryness was a big factor. Because I’d been taken off the HRT because of the oestrogen problem. I went to see another GP, a very nice lady GP in the surgery and asked her what I could do and she got permission from my surgeon to prescribe oestrogen cream. Which I used for about three months and I think it possibly had some effect but when I went to get a repeat prescription they wouldn’t let me have it. So I don’t know whether their thinking had changed. So I had about three months of it but, the problem being solved, the skin had got so much thinner that it was tearing and it was very, very uncomfortable. My husband is extremely considerate and gentle but it did make it very, very difficult.

In the last three or four years the vaginal skin has got very, very thin. It tears very easily now, I bleed very easily. Which is disconcerting in the extreme. And puts you off the fun.

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.
 

Dr Sally Hope explains that declining levels of oestrogen can weaken the pelvic floor and cause...

Dr Sally Hope explains that declining levels of oestrogen can weaken the pelvic floor and cause...

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What about urinary problems, bladder problems, those sorts of things? Are they more common around the time of the menopause?

Yes. What you have to realise is that oestrogen affects the whole body. It affects our collagen, the springy stuff that affects our skin so that’s when we get more wrinkly after the menopause and there is a lot of collagen in our pelvic floors. Our pelvic floor is the webbing like in a chair that stops your womb and bladder falling out between your legs and we’re not really evolved for standing upright. If we were on all fours it would be all right but we’re standing upright so there’s a huge pressure on our pelvic floor to try, with all the organs there, against gravity and during the menopause and after the menopause our oestrogen levels go down, our collagen becomes more saggy so the whole pelvic floor sort of sags like a chair that needs reupholstering and the bladder and the womb, the vagina and the bowel can all slip down through the support buttress of the pelvic floor. So you can get faecal incontinence, which is mortifying, bladder irritability or incontinence and also your womb can come down, or your vagina can come down and that’s called a prolapse.

So women can feel something coming down. Especially a lot of women in our age-group are being more active, they’re doing aerobics, they’re running the London marathon and these things can get in the way because they can actually feel it when they’re doing exercise. It pushes it down if they do a lot of weights.

And what can they do about it?

You can do pelvic floor exercises. There are specialist pelvic floor physiotherapists and if you do your pelvic floor exercises it really does work. Also you can take local oestrogens, if you don’t want full hormone replacement therapy, which I think we’ll come on to in a minute, you can put local oestrogen, so that’s a tablet or a pessary, ring or cream, in your vagina so it’s absorbed locally into the vagina and it actually can help lessen urinary problems because it gets into the bottom of the bladder and stops it being so irritable and also helps local vaginal dryness and pain with sex. So for a lot of women that’s a good solution because they don’t want the risks of full HRT and you can stay on local oestrogen forever.

 

Mary wonders if her urge incontinence is connected with the menopause

Mary wonders if her urge incontinence is connected with the menopause

Age at interview: 57
Sex: Female
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Any problems with urinary tract and so on? Going to the toilet?

Well that’s interesting isn’t it?  No I mean I have, I don’t have any problems in that respect although from time to time I do find I need to get to the loo in a hurry and especially if it’s cold and I’ve been out for a long time and haven’t been, I get in and actually don’t quite make it. I’m not sure whether that’s a characteristic of the menopause or a characteristic of being rather unfit and overweight. I mean I know women who’ve had babies often have that problem which is, I’m not sure, it’s urge incontinence I think that’s what it’s called, as distinct from the stress incontinence which I believe is the one where you have incontinence when you take exercise or sneeze. I don’t have that, but I do have urge incontinence. When I need to go, I need to go. But it’s not severe and it’s not enough to warrant being worried about. But I’m not sure it’s associated with the menopause, is it? I don’t know.

 

Maggie’s had painful ‘cystitis-like’ symptoms but doesn’t know if the menopause is to blame

Maggie’s had painful ‘cystitis-like’ symptoms but doesn’t know if the menopause is to blame

Age at interview: 49
Sex: Female
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Yeah, it’s [my health’s] been very good apart from the fact that I had about nine months of very painful bladder symptoms, within that time, and I don’t know if there’s any connection with my hormonal level but I ended up having a cystoscopy and they removed some scarring and since then it’s been much much better.

And what were the symptoms?

Cystitis like symptoms, but not responding to any antibiotics. And not showing up any kind of bacteria, so it was very very uncomfortable and I had a specific pain sort of right at the urethra where the urine comes out and that was more or less constant every day, it was very uncomfortable.

Did they relate that to the menopause?

No. No. I did go to a gynaecologist for my first appointment, the consultant, and he gave me the all clear, from that side but that, it was so segmented, so the urologist didn’t refer to any kind of menopausal changes at all so I didn’t make any links, and whether there are any I don’t know, I tried to research it a bit, but I couldn’t find any,

And did that go away after the treatment they gave you?

It did yeah. I mean I get slight symptoms coming back every six months or something, and I might get some cystitis like symptoms but they seem to come and go quite quickly.

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.
 

Christina’s stress incontinence has affected her life

Christina’s stress incontinence has affected her life

Age at interview: 52
Sex: Female
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I mean it is now a life without having to worry about sanitary towels or anything else.

But it’s now a life of worrying whether you’re needing Tena-lady supplies and things like that because of a weak bladder control and your pelvic floor goes.

Have you experienced that?

Yes, yeah especially with coughing. I think they call it stress incontinence. So it’s just another thing of ageing.

And that’s been happening since you’ve been going through the menopause?

Yes, yeah. More particularly the last four years, five years.

And is that during the day that happens?

Yeah. And especially when you’ve been to the toilet and then you get in the car and you’re going home and you’ve got your key in the door and you’re thinking, “I need the toilet quickly.” So it’s like drop everything and dive upstairs.

And are you getting up a lot in the night to go?

Not particularly during the night because I stop an intake of fluid. My last drink is probably about 8 o’clock at night and then I go to the loo. So then of course I’ve got the sweats and it’s horrible. It really is horrible.

Have you talked to your doctor about the stress incontinence?

Yeah, and he [said] do more pelvic floor to try and tighten up a little bit.

And has that helped?

Not really, no. I get some funny looks sometimes if I’m out. Especially in the car and you’re going whooer whooer. Nobody is supposed to know that you’re doing these but my face tells a different story.

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.

 

Last reviewed July 2018.

Last updated December 2012.

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