Sex should not hurt. Losing desire is common. Neither is something to put up with.
What changes
Lower oestrogen thins and dries vaginal and vulval tissue, so arousal takes longer and sex can hurt. Blood flow to the clitoris falls, so orgasm can feel weaker or take longer. Testosterone declines gradually with age. Desire often shifts from arising on its own to arising after touch and arousal begin.
Why desire drops
The causes stack up. Pain with sex. Poor sleep. Low mood and anxiety. Antidepressants, blood pressure medicines and hormonal contraception. Body image. Stress, fatigue and caring load. The state of the relationship. Hormones are one factor, not the only one.
Low desire is only a problem if it bothers you. If it causes distress, it is a recognised and treatable condition called hypoactive sexual desire disorder.
This is the work The Shift Method was built for: comfort, desire, connection and identity, once the symptoms are treated.
See The Shift MethodWhat helps, in order
Treat pain first. Vaginal oestrogen or regular moisturisers fix most dryness and pain within eight to twelve weeks.
Then treat sleep, mood and hot flushes. Review medicines that lower desire. Some antidepressants can be switched or adjusted.
Talk to your partner about what has changed. Responsive desire is normal. Starting with touch, without pressure for intercourse, often lets desire follow.
Pelvic floor physiotherapy treats pain, tightness and leaking. Sex therapy treats desire, anxiety and relationship patterns.
Testosterone
For postmenopausal women with distressing low desire, the international consensus supports a trial of testosterone applied to the skin. Blood levels are checked before starting and after three to six weeks, and kept within the normal female range. If there is no benefit by six months, it is stopped.
In Australia, a 1 percent testosterone cream is approved for women. In most other countries it is prescribed off label using carefully reduced doses. It is not recommended for low energy, mood, memory or bones.
After cancer
Cancer treatment, especially chemotherapy and aromatase inhibitors, can cause sudden and severe sexual changes. Moisturisers, lubricants, pelvic floor physiotherapy, dilators and sex therapy all help. Vaginal oestrogen can be discussed with your oncology team.
See a practitioner if
- Sex hurts
- Loss of desire distresses you
- You bleed after sex
- You cannot tolerate a tampon or an examination
Common questions
Is it normal not to want sex any more?
It is common. Whether it is a problem is your call. If you miss desire, there are effective treatments.
Which lubricant should I use?
Water based lubricants suit most people and condoms. Silicone lasts longer. Avoid products with fragrance, warming agents or glycerine if you are prone to irritation.
Does testosterone make you grow facial hair?
At doses kept in the female range, side effects are uncommon. Mild acne or extra hair growth can occur and usually settles when the dose is reduced.
- Global Consensus Position Statement on the Use of Testosterone Therapy for Women, 2019
- International Society for the Study of Women's Sexual Health, clinical guideline on testosterone, 2021
- The Menopause Society, 2020 Genitourinary Syndrome of Menopause Position Statement
This page is education, not medical advice. Talk to your doctor or menopause practitioner about your own care. In an emergency, call your local emergency number.