Menopause and libido: what pleasure and desire after 50?

According to one investigation published in 2020, 15% of menopausal or pre-menopausal women have difficulty transitioning to menopause And 36% notice a drop in their sexual desire (libido). Menopause occurs on average around 51 years old. But physiological and hormonal changes can occur earlier, around the age of 40-45, during perimenopausea period of time which includes the period of irregular menstrual cycles preceding menopause and the year following the actual cessation of periods, or later, around age 55.

Does desire necessarily decline at menopause?

“Menopause is marked by hormonal changes such as a drop in estrogen levels which are hormones playing a role in libido but they do not intervene alone. There are also hormones in the adrenal glands – testosterone – which act on sexual desire. These hormones do not drop at menopause. There libido is therefore not only linked to estrogens and can remain normal after menopausereassures Dr Christelle Besnard-Charvet, gynecologist-obstetrician. The desire can exist until 50, 60 years old… or even until the end of life!“

Why can pleasure decline at 50?

► A drier vagina: Women often confuse desire with pleasure. “A woman can really want to make love, without necessarily being mechanically capable of it.“, specifies Dr. Besnard-Charvet. Indeed, if the libido is mainly linked to the psychological sidesexual pleasure and the attainment ofOrgasm are under the dependence of estrogen. “We then speak of “mechanical” or “physical” problems. Estrogen deficiency often leads to a lack of vaginal lubrication, which may therefore take longer to obtain. However, it is a real vicious circle: intercourse can become less and less pleasant, even painful for certain women. And these pains can cause apprehension or negative anticipation during subsequent intercoursewhich can, in the long term, have an impact on sexual arousal and the desire to make love. explains the gynecologist.

► Atrophy of the vulva and vagina: At menopause, the vulva and vagina undergo physiological changes. “Women with severe estrogen deficiency may experience a genitourinary atrophy syndrome that can make intercourse mechanically difficult“, indicates our interlocutor. This syndrome is characterized by thinning of the vaginal wallswhich can cause discomfort and pain during intercourse (dyspareunia). “Obviously, this syndrome varies from one woman to another. There are patients who, 5 to 10 years after menopause, can no longer insert a finger into their vagina. Others in whom we do not necessarily notice vulvovaginal atrophy“, she nuances. Problem: women do not always dare to talk about it to their doctor. However, genitourinary atrophy can really affect comfort during sexual intercourse, impact intimacy within the couple and more generally alter self-esteem.

► Vaginal odors: No longer having hormones in the vagina unbalances the flora: the lack of estrogen leads to a reduction in “good bacteria” in the vagina and promotes the appearance of “bad bacteria” (Gardnerella, Streptococci B, etc.) which are absolutely not dangerous, but can cause smelly vaginal discharge. These intimate smells can decrease self-confidence, desire and increase discomfort during sex. “These smelly odors are not serious and are not a sign of infection : to reduce them, it is generally enough to take a little hormones (local hormonal treatment based on estriol) or vaginal probiotics. In all cases, you have to accept that your body is changing and tell yourself that there are medical solutions which you should not deprive yourself of“, advises Dr. Besnard-Charvet.

► Psychological reasons: “Libido is not completely hormone dependent. The psychological side matters a lot“, continues our interlocutor. The libido can be affected by a certain psychological or emotional discomfort due to hormonal fluctuations during menopause: we see our body change, gain a few kilos, we are more anxious, more irritable, more stressed, we have less self-confidence...and all this impacts intimacy. The best thing is to talk to a doctor – whether a gynecologist, a midwife or a sex therapist – to overcome these changes and regain a satisfying intimate life.

What solutions for a satisfactory sex life after 50?

There are preventive actions to avoid genitourinary atrophy syndrome. “I advise women who have not had a partner for a while to monitor their vagina by trying to insert one or two fingers inside. Overall, if the woman can insert two fingers without it hurting, intercourse is possible. On the other hand if she is in pain, she must consult a health professional (gynecologist, midwife) to benefit from a suitable solution“, recommends the gynecologist.

You have to “train your vagina”

“Ideally, you should “train” your vagina and have intercourse regularly to prevent it from shrinking and also because semen contains substances that lubricate the vagina and increase the flexibility of the mucous membranes“, argues the specialist. If you don’t have a partner, this prevention “exercise” is completely sufficient. Women who are not comfortable with their body can, if they wish, go to a doctor (midwife, gynecologist) who, approximately once a year, will look at the condition of their vagina and offer them appropriate treatment. Depending on the patient, the health professional can prescribe:

• local hormonal treatment based on estriol, which has great effectiveness on atrophy and vaginal lubrication. However, this type of treatment is only suitable for women who have no contraindications to hormones (i.e. no known breast cancer or history of breast cancer, history of thromboembolic disease, estrogen-dependent tumor …)
• a treatment based on hyaluronic acid (in gel or ovules, to be applied two to three times a week) which has a softening effect for the vagina. This type of treatment is hormone-free and may be suitable for women who have a contraindication to hormones.
• water-based or silicone lubricants which help lubricate the vagina and facilitate penetration. It is better to avoid petroleum jelly-based lubricants which can make condoms porous and irritate the mucous membranes.

A more fulfilled sexuality at 50?

Of course, sexuality is not the same at 20 as it is at 50. But it can be more fulfilling and an opportunity to discover new pleasures. “The milestone of menopause in a woman’s life corresponds to a period when children will become independent and leave the family home; she will find herself alone facing her companion. [La femme peut] see it a new freedom And feel desirable and desiringreports the National College of French Gynecologists and Obstetricians (CNGOF) in an article on “Menopause and after?” This period presents itself as a freedom from the risk of pregnancy and the ritual of menstruation, source ofa resurgence of sexuality with an ever-desiring body and an ever-rich imagination. Overall, for many women, post-menopausal sexuality remains very pleasant and fully satisfying..”

They are full of self-confidence and very often want to make love.

With years of experience and generally having known several partners, the woman also knows her body better and the way it reacts. She has acquired self-confidence which allows her to be better able to define her favorite positions and the most erogenous parts of her body. She listens to her desires, her desires and may be curious to try other experiences or discover other practices…”I have among my patients many 50-year-old women who have separated from their partner with whom they remained in a relationship for a very long time and who fall madly in love again with a new partner. They are full of self-confidence, have a lot of excitement and have very often want to make love. They find the ardor and passion which they had lost a little before. In all cases, knowing yourself, accepting physical changes, being aware of your desires and sharing them with your partner are the best ways to maintain a fulfilling intimate life.“, concludes Dr. Besnard-Charvet.

Thanks to Dr Christelle Besnard-Charvet, obstetrician-gynecologist.