Libido, Female Sexuality and Menopause

Does menopause quash or quicken your libido? It is little difficult to judge what the effect of menopause is on libido because it appears that there are different factors involved in maintaining sexual libido in women such as testosterone levels, physiological and psychological factors.

Sexuality is more than the biologic urge to reproduce. It involves the timeless desire for emotional and physical intimacy. Sex can be one of the most gratifying experiences that life has to offer at any age. With maturity, sexuality can be expressed in a variety of ways, including shared interests, companionship, and holding hands at the movies as well as through sexual intercourse. Sexual desire or libido, like your body, changes as you progress through life, but the desire to be sexual is never extinguished for most people.

Factors influencing libido

Sexual desire, or libido, is a blending of several diverse influences:

  1. Hormone production (estrogen), which accelerates at puberty, causing sexual organ development and body growth
  2. Testosterone production, resulting in fantasies in both genders
  3. Psychological development, which contributes to knowledge and attitudes about sexuality
  4. The social influences of cultural, religious, and family perceptions of sexuality
  5. Physical development and general health

Libido is the net effect of these influences, resulting in sexual fantasies, sexual arousal, and the motivation to have sex.

Psychological influences on sexual desire

Your brain is the most important and sensitive sexual organ throughout your life. Many women lose their libido solely because of psychological influences. It is believed that the most influential factors by far are psychological. Attitude is the keystone of a healthy sexual life, so let’s talk about some factors that affects your attitude toward sex.

Past experience: If sex has been an enjoyable and integral part of your life, your sexual desire should persist in spite of the biological changes that perimenopause and menopause bring. Some women at midlife no longer want sex. This may be due to past experiences such as cultural influences, trauma, and relationship problems. If your desire for sex has diminished or if sex has never been enjoyable or fulfilling for you, the biological changes of late perimenopause and menopause may provide a convenient reason to opt out of being sexually active.

Stress: If you are worried about a serious illness, a family crisis, or a financial problem, having sex may be very low on your agenda of important things to do. Solving the problem usually restores your sexual desire and libido.

Depression: Depression may have a dampening effect on sexual desire. In one study it was found that more than 70 percent of depressed patients had a loss of sexual interest when not taking medication, and they reported that the severity of this loss of interest was worse than the other symptoms of depression. In this same study, libido declined with increasing severity of psychological illness

Lowered libido after the treatment of depression Consistent evidence shows that, with the exception of bupropion (Wellbutrin), trazodone (Desyrel) and nefazodone (Serzone), antidepressant medications may cause a decline in libido or sexual functioning despite improvement of depression. Up to one half of patients surveyed before and after starting therapy with the SSRIs fluoxetine (Prozac), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa) and sertraline (Zoloft) reported a decline in libido with medication use. SSRIs also cause other sexual dysfunction that can affect libido and compliance.

Physical vitality Many good reasons to remain physically active and in good physical health. Here is one more: Sexual desire and libido can remain high if you feel physically fit.

Self-Image Another psychological challenge for women in the perimenopause and menopause years is to resist the cultural stereotype of what constitutes a sexy woman. Worry about physical attractiveness quickly translates to worry about sexual attractiveness, and dampness desire. your body is not like it was two decades ago. This is true of men, too, of course, but it is culturally more acceptable to be a man whose hair is graying and whose middle is growing than to be a woman with physical characteristics of midlife. your healthy sexual desire is intimately involved with your understanding that good sex does not require a perfect body.

Biological Influences on Sexual Desire

Along with the significant psychological factors previously mentioned, a broad range of biological factors influence sexual desire. While these factors can have a potent effect on your desire, they are not nearly as influential as your sexual attitude. according to the landmark work of Masters and Johnson who pioneered research into the nature of human sexual response and the diagnosis and treatment of sexual disorders and dysfunctions from 1957 until the 1990s,female response to sexual stimulation falls into four stages: 1. Sexual excitement: Sexual excitement can begin in any number of ways- with fantasies, hugs, stroking, kissing. Your pelvic blood vessels dilate and congest the region with blood. Vaginal lubrication results, as very slick secretions pour out throughout your vaginal walls. Muscles throughout your body begin to tense. 2. Plateau: In the plateau phase, your sexual arousal increases dramatically. Clitoris becomes enlarged from blood engorgement and sensitive to being touched. The folds at the entrance of your vagina (labia) become swollen from blood engorgement. Your heart rate and rate of breathing increase, and you may be perspiring. Your upper vagina becomes dilated and lengthened, while the muscles surrounding your lower vagina tense. 3. Orgasm: this is the climactic moment of sexual response. Rhythmic contractions occur in your uterus and lower vagina. 4. Resolution: During this phase, pelvic vascular congestion promptly subsides. You are engulfed in a feeling of profound relaxation during which peace and warmth and closeness may be maximal.

Changes of four-stage sexual response throughout life:

This four-stage pattern of sexual response remains generally unchanged throughout life, although individual components may vary as time passes. What excited you sexually at twenty may be very different from what works a couple of decades later during menopause. Lubrication may take longer, reaching an orgasm may also take longer, be less intense, and occur less reliably, and the intensity may also change. During your perimenopausal years, none of these may be an issue. If they are, there are many steps you can take to manage them. As for postmenopausal years down the road, take comfort in knowing that women at any age can enjoy sex.

Role of Hormones in Sexual Desire


A landmark 1958 study on sex hormones divided women whose ovaries had been removed into four groups. Each one of four types of medication: estrogen, testosterone, a combination, or a placebo. The groups on testosterone or estrogen plus testosterone reported an increased level of libido, arousal, and sexual fantasizing, while those on estrogen or a placebo did not. Testosterone, according to this study and others, is the hormone behind sexual desire and libido. By contrast, estrogen’s role is more closely connected to physical aspects of sexuality, such as vaginal lubrication, other arousal responses, and orgasm. Estrogen mediates these responses through receptor sites on the nerves that supply vaginal canal, clitoris, and other pelvic structure. By contrast, testosterone mediates its effects directly on receptor sites in your brain. These studies and others have resulted in the increasingly common use of testosterone to boost female sexual interest and fantasizing.

Acknowledged criteria for use of testosterone replacement therapy

  • Significant loss of libido- no motivation, fantasies, or arousal
  • Global libido loss- nothing and nobody is a turn- on
  • Diminished sense of well-being • Inability to become aroused, no matter what
  • Significant loss of nipple and/or clitoral sensitivity
  • Inability to have orgasm, or severely diminished orgasm quality
  • Loss of pubic hair
  • Fatigue, depression, irritability, nervousness, insomnia, or poor concentration

DHEA DHEA (Dehydroepiandronsterone) is a weak male hormone that has been the subject of much hype and promotion in the food supplement industry as a fountain-of-youth additive. While small studies to date have shown a direct effect on improved sense of well-being with DHEA, most have not shown a direct effect on sexual motivation and fantasies. One recent study did find improved sexual desire with DHEA (Arlt 1999).

Sexual problems from lowered hormone levels are not common during perimenopause, but there are exceptions: If your ovaries have been removed or if you are taking low dose birth control pills, you may need a testosterone supplement to maintain normal levels of sexual desire. The pill lowers free and active testosterone levels.


The functioning of clitoris, vulva, vagina, and uterus depends upon estrogen support. When estrogen is withdrawn, there is a 60 percent decrease in the blood supply to the genital area and these structures undergo atrophic changes. Such changes can have an adverse effect on sexual arousal and pleasure. Vaginal canal may be the first one to be effected. Diminished blood supply causes thinning of your vaginal lining and a reduction in mucus production. Long before your doctor can see any evidence of thinning, you may notice a reduction in moisture. After menopause, if you take no preventive measures, these changes can become more extreme. Vulvar changes from estrogen deficiency are slow and mainly

postmenopausal.The vulva is the external portion of the female genital organs. It includes the labia majora (two large, fleshy lips, or folds of skin), vestibule (space where the vagina opens), prepuce (a fold of skin formed by the labia minora), clitoris (a small protrusion sensitive to stimulation), fourchette (area beneath the vaginal opening where the labia minora meet), perineum (area between the vagina and the anus), anus (opening at the end of the anal canal), and the urethra (connecting tube to the bladder). The skin covering labia becomes thin and inelastic. Fatty tissues is lost and the labia appear shrunken. There is less pubic hair. Valvar dryness may cause an itchy condition, called pruritis. With estrogen depletion, uterus, including cervix, also shrinks over time. In rare cases, painful uterine contractions occur during orgasm. Clitoris will have fewer functioning nerve fibers, so it will be less sensitive to stimulation. Other estrogen related changes can also interfere with your sex life. For example, if hot flashes are depriving you of sleep, you may be too tired to enjoy sex. Or your sensory perceptions may be altered since an adequate estrogen level is a factor in the sensitivity in the sensitivity of skin nerves.

Medical Illness and Your Sex Life

A major physical illness at any age can affect both your interest in having sex and your physical ability to do so. If the illness is temporary, desire usually returns when you start feeling better. However, some chronic diseases may have long-term effect:

  • Arthritis and orthopedic problems
  • Chronic heart or lung disease
  • Diabetes
  • hypothyroidism due to profound fatigue
  • Sexually transmitted disease (STD)
  • Pain with sex
  • Depression
  • Drug side effects: Antidepressants, tranquilizers, Blood pressure drugs, alcohol, steroids abuse for muscle building, smoking, recreational drugs.

Some Tips:

  • Enlist your partner as a fellow problem-solver
  • Find out more about your partner’s sexual needs and preferences
  • Don’t be confrontational
  • Regard this as a process, as opposed to an event
  • Nonverbal communications works , too
  • maintaining vaginal moistness by regular sexual activity ( it doesn’t have to be intercourse; other techniques, such as self-stimulation and non vaginal sex with your partner, can work just as well
  • Using water based lubricants. Avoid lubricating with petroleum based products such as Vaseline. They weaken latex condoms and may mask the signs of vaginal infection
  • Consult with Women’s health professionals regarding Bio-identical hormone replacement therapy to see if you need them.
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