The majority of women that I see in my clinic have a low libido. This is a common symptom of the peri menopause and menopause. So, where does it go?

Libido is a complex phenomenon; several factors play a part and overlap. I like to break it up into the 4 ‘H’s - head, heart, hormones and husband (or whoever your sexual partner is, ‘husband’ is for simplicity but of course for many of us it’s not a ‘husband’).

Head

This is our mind, thoughts and feelings. In midlife our bodies often change, sometimes this can lead to us feeling less confident about ourselves physically and can negatively impact on our ability to feel ‘sexy’. Change does not mean bad, but it can lead to a negative shift in our perception on how we look. Our mind also controls how we feel in general. If we feel stressed and worried, we are less likely to feel in the mood for sex.

Heart

This refers to how we feel emotionally about our sexual partner. Most of us need some feeling of connection to want to have sex with someone. It can sometimes be very challenging to maintain a connection with a partner, for various reasons a distance between people can develop and grow. This can be exacerbated by one person in the partnership having a low libido and avoiding closeness with their partner in order to avoid having to ‘reject’ their sexual advances. If there is a wish to regain or maintain emotional connection, sometimes this has to be prioritized. Making time in your day or week to do something together can help, for example ‘date nights’ or doing a daily task together such as walking the dog or cooking together. Carving out time to just be together in order to provide a forum to allow for quality communication can help. Really listening to your partner without distractions can be hard to achieve with the businesses of day-to-day life. Also maintaining some physical touch can help. This may involve a holding hand, a quick hug or kiss, or sitting close together to watch a film. Having these habits as part of your relationship can help connection. Everybody expresses ‘love’ in a different way, sometimes we are missing how our partner is expressing their love and this leads to misunderstanding. Some couples benefit from time with a relationship counsellor to help ease their communication through a challenging point in their relationship.

Hormones

In midlife often hormones are changing. Dipping oestrogen and testosterone levels can lead to a myriad of symptoms. Libido is affected by low oestrogen and low testosterone in the peri menopause and menopause. These hormone changes can also lead to anxiety, low mood, poor sleep and fatigue, all of which commonly reduce sex drive. Hormone reduction can lead to vaginal and vulval dryness, itching, soreness and urinary symptoms, making penetrative sex less appealing and sometimes painful. When looking to improve libido these vaginal and vulval symptoms must be addressed also. Low testosterone can affect the quality of a sexual experience and for some women can lead to difficulty reaching orgasm.

‘Husband or Your Sexual Partner or Partners’

Midlife can lead to changes in your partner which may affect their libido and sexual functioning. This can affect their confidence in achieving a satisfactory sexual experience for them and their partner. Sometimes it can be helpful to approach a shared sexual experience differently than before. Using sex toys, lubricants and having some fun exploring new things can help take tension out of sex. Of course, intimacy does not have to involve penetrative sex. Sometimes couples find seeking some advice from a sex therapist can give their sex life a fresh approach.

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