Sexuality in menopause


by Christiane Northrup, M.D.


Do you remember the first time you fell in love? Chances are you thought you had discovered the moon and the stars. The lyrics to songs seemed to be written about you. And you probably didn’t even think about eating or sleeping. When a woman falls in love, she experiences an almost overwhelming influx of energy, filling her with exhilaration, benevolence, vigor, creativity and often insatiable sexual desire.

This first-love feeling can be experienced at any life-stage or age when we are able to connect at a deeply emotional and spiritual level with another person. But at midlife, the challenge for most women is to be able to access that in-love feeling in ways other than looking to another person for fulfillment and gratification. In other words, if you think of sexual energy in the largest possible context – as life force, or Source energy – then it is easy to see that the health and vitality of our sexuality is inexorably linked to the health and vitality of our lives.

Listen to your body

It is a common misconception that sexual desire and activity inevitably decrease at menopause. Although this is true for some women, it certainly doesn’t have to be the truth for all. What we believe about sexuality at menopause has a lot to do with our sexual expectations and experience. And many women who are in the process of negotiating how to tap into their source energy at midlife notice a decrease in sexual desire. In one study, 86 percent of women reported some form of sexual dysfunction, usually in the form of loss of sexual desire, often associated with vaginal dryness, dyspareunia (pain during intercourse), vaginismus (painful spasms in the vaginal muscles), loss of clitoral sensation and touch sensation impairment.

Determining the cause of sexual problems can be difficult. Sometimes, menopause-related hormone deficiency is to blame. But sexual function is a complex, integrated phenomenon that reflects the physical health of not only the ovaries and hormone balance, but also the cardiovascular system, the brain, the spinal cord and the peripheral nerves. In addition, there are almost always underlying psychological, sociocultural, interpersonal and biological influences that affect individual sexual function. Interestingly, of the 14 percent of women in the study who reported no sexual problems, one-third admitted they had previously had sexual problems but that the problems had been resolved when they found new sex partners.

It is also important to note that health conditions and medications may also interfere with sexual functioning. Women suffering from gynecological problems, hypertension (high blood pressure), diabetes, chronic pain, alcoholism, drug use (including cigarette smoking), thyroid deficiency or depression, as well as those who use anti-hypertensive medications, tranquilizers or sedatives, ulcer medications, glucocorticosteroids, antihistamines or antidepressants, may suffer some sexual dysfunction.

What causes this? Are you worried about perimenopause and how it will affect your sex life? Many of the following midlife changes in sexual function have been associated with normal perimenopause:

  • Increased sexual desire
  • Change in sexual orientation
  • Decreased sexual activity
  • Vaginal dryness and loss of vaginal elasticity
  • Pain or burning with intercourse
  • Decreased clitoral sensitivity
  • Increased clitoral sensitivity
  • Decreased responsiveness
  • Increased responsiveness
  • Fewer orgasms, decreased depth of orgasm, increase in orgasms, sexual awakening.

As you can see by this list, change itself, and not the nature of the change, is the common theme. It’s important to remember that during the perimenopausal transition, with all of its changes, a woman’s libido may go underground for a while as she reprioritizes her life and the manner in which she uses her energy. This is perfectly normal and can yield great dividends. But it is only temporary. There is no reason for diminished sex drive to become permanent after menopause. And while some women truly do notice a decline in libido at menopause, others actually experience heightened sexual desire and activity after menopause.

Dr Northrup

NOV. 3
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Copyright Christiane Northrup, Inc. All rights reserved. Reproduction in whole or in part without permission is prohibited. This information is not intended to treat, diagnose, cure or prevent any disease. All material in this article is provided for educational purposes only. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding a medical condition, and before undertaking any diet, exercise or other health program. For more cutting edge articles on health and wellness, visit and sign up for the Women’s Wisdom Circle.

Christiane Northrup, M.D., a board-certified ob/gyn, is a visionary pioneer, beloved authority in women’s health and wellness and the author of the ground breaking New York Times bestsellers, including the newly revised Women’s Bodies, Women’s Wisdom and The Wisdom of Menopause. Her third book, Mother-Daughter Wisdom, was voted Amazon’s #1 book of 2005 (in two categories). Her latest books, The Secret Pleasures of Menopause and The Secret Pleasures of Menopause Playbook, teach how to experience joy, pleasure, prosperity, fulfillment and vibrant health. Following a 25-year career in both academic medicine and private practice, Dr. Northrup now devotes her time to helping women truly flourish on all levels through tapping into their inner wisdom.


Sarrel, P. & Whitehead, M.I. (1985). Sex and menopause: Defining the issues. Maturitas, 7 (3), 217–224.

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