Menopause & perimenopause
Rekindling desire — the soul of your libido
by Marcelle Pick, OB/GYN NP
Remember the freedom we felt in our late teens and early 20’s? I heard one patient say, “Back then, it seemed like life was an endless summer, wide open with possibility.” Whether you came of age during the sexual revolution, when there were few restrictions on love-making, or soon after during the discovery of AIDS and the emphasis on protection, it was easy to desire sex when we felt sexy!
Now as we approach our 50’s and move through menopause and beyond, it can be difficult to find the freedom and confidence that once fueled our desire. Many women I talk with are plagued by fear — fear of their maturing bodies, fear of looking like their mothers and grandmothers, and most of all fear of becoming marginalized by a society that seems only to value youth. These feelings along with the cultural message that an active, vibrant sex life at midlife is somehow inappropriate or unattainable can undermine your sex life and leave you wondering if sex is really as important as you once believed. But trust me, there’s hope!
For some women, a less active sex life may feel fine — they may even be relieved. But for those women who would like to be thinking about and having more — and better — sex, I want to share this happy truth: there is no time limit on the ability to experience desire, no deadline for your sexuality, and no expiration date for intimacy. In fact, with a little work and the right support, many of my patients report having the best sex of their lives after menopause!
Address the physical...
Could physiological changes be undermining your desire for sex? It’s worthwhile to consider any physical possibilities. You may be surprised to learn that hormonal shifts are related to loss of libido in menopause.
Some women experience vaginal dryness or vaginal atrophy with a decrease in estrogen that can make intercourse less enjoyable, or painful. Others may have more difficulty sensing stimulation. Hot flashes, night sweats, and insomnia take their toll on energy levels causing fatigue. Medications, too, can dull libido.
The good news is that all of these physical problems are relatively easy to diagnose and treat. Read our article on low libido in women to learn more.
Naturally, women’s bodies change physically as we transition from perimenopause to post menopause, and some physical concerns can make arousal, intercourse, and orgasm different (or more difficult to achieve) for some. We address these issues at length in our article on sex drive and libido in women. But what I’d like to discuss here is the more intangible part of the sexual equation — your emotional sexual state — and how to refuel it.
How physical changes in menopause affect sex drive
At first it may seem natural for a woman’s libido to mirror the slow waning of fertility in perimenopause. But why should this be so? After all, Nature provides both genders with the ability to enjoy sexual pleasure throughout life, and blesses us equally with the many health benefits of sex: greater longevity, slower aging, lower risk of heart disease, improved fitness, and better sleep, to name just a few that are well-studied and documented.
So many of the women I talk with consider themselves less and less sexual beings, as the years go by. Mentally they may feel 25, but as they look in the mirror and notice skin and hair changes, or shifts in musculature and weight, they may believe that their sex lives should be winding down too.
Self-esteem is essential for fostering desire. Too often we internalize society’s adulation of the young “hot” body. I recognize that a huge segment of women hear an internal script of negative thoughts from adolescence on — a negativity fueled by the media, thin models, and cosmetically altered and retouched icons of beauty. Women slave at the gym, starve themselves, and sap their natural strength and sensuality to live up to some unattainable cultural ideal, then internally berate themselves when they can’t. It’s no wonder that many women continue to obsess over their perceived physical imperfections into middle age.
One of the joys of menopause is that it offers the opportunity to examine your inner beliefs, including any “truths” you may hold about beauty and personal power. It’s a time to shrug off the cultural ideal of what’s attractive, and discover what you know to be truly beautiful about yourself.
Feeling sexy — the mind-body link in libido
Loving your body starts in your own head and heart. The mind, specifically the limbic system (which has been described as the emotional seat of the brain), is the single most important organ when it comes to sexual arousal and desire — and the spark of desire is kindled long before any of our body parts touch. In effect, desire begins with a state of mind.
One of my patients once told me, “I used to get upset when a man would stare at me as I walked by. But I didn’t realize what it would be to walk down the street and have no one notice. Now I just feel invisible!”
I reminded her that whenever we allow others to dictate our worth, we give them control over something very valuable indeed. How many times have you met someone who on the surface isn’t classically attractive, but whose personality makes them irresistible? This attractiveness begins with a strong sense of love for themselves. It may sound cliché that you have to love yourself before someone else can, but so many women I meet have trouble internalizing this truism, and connecting lovingly with themselves.
Because desire is a function of how desirable you feel, you may need to redirect your mind each time the negativity script starts to play. It may not be easy, shifting to a place where you can hear and accept compliments and affirmations from yourself and others. Any woman who has struggled with her self-esteem and appearance can tell you this. And you may need some professional guidance. Many of my patients have successfully revised their inner monologues with one-on-one counseling, EFT, or a program like the Hoffman Quadrinity Process.
In order to rekindle your desire, you must claim it in your own mind. So grant yourself permission to be a creative, fully expressed sexual creature. This is possible, whether you’re 49 or 90, when you learn to fall in love with yourself and appreciate how truly unique and desirable you are.
How does a woman at midlife or beyond go about reclaiming her sensual self?
De-stress to put sensuality back in your life
We all know that women in perimenopause and menopause face a host of stressors. Many are dealing with teenaged children, newly empty nests, divorce, or other troubling relationships. Parents, too, grow older and require caretaking. All the while, women are working full-time in professional and volunteer capacities, and usually taking care of the home as well. Not only do these many demands divert your body’s resources into making stress hormones instead of sex hormones, they leave little room for mind and body to indulge in creative thoughts and activities that cultivate desire.
And creativity and sensuality go hand-in-hand. Remember as a teenager, mooning over the local heartthrob or just lying around, listening to music and writing in your diary? What may in retrospect seem like a frivolous waste of time served a useful purpose. It gave you a chance to tune in to your fantasy world, to learn what you liked. It helped to prime your psyche to accept love and passion when they happened along.
One sure way to bring sexual excitement back into your life is to allow time for it. This is so much easier if you can reduce the amount of space stress takes up in your life. How many people find their sexual desire increases when they go away on vacation? It’s no mystery; it’s about giving your body, mind, and spirit the room to relax and have fun.
So you may need to establish better boundaries, to help rekindle your sexual nature. This may mean changing your routine to include some uninterrupted downtime. It may mean carving out time for creative pursuits that literally “turn you on.” I’ve had patients who, upon traveling or taking up some other passion they’ve sequestered for years, find themselves feeling young again, energetic and — yes — sexy! No matter how old you are chronologically, your desire will always be that teenage girl daydreaming on the bed. All she needs to bloom is support, time, and of course, the right partner.
Which brings me to communication and its long-term bedfellow: intimacy.
Talking with your partner about your needs
We have a saying at the practice: “If your upper lips don’t talk, the lower ones will,” which means that if you can’t say it out loud, your body will do it for you. If you are having difficulty in your relationship on an emotional level, it will influence your physical relations, and eventually your desire may wane.
Creating and maintaining intimacy in a relationship is a deep subject, but as it relates to desire I will say this: Learning to love and protect yourself is one step; figuring out what you need in bed is another. Asking for what you need can be difficult for some women, and may open up a Pandora’s box of emotional issues.
This difficulty may relate to living in a society that remains conflicted about sex beyond its necessity for reproduction. Corporations know it sells product, but — in contrast to many other cultures — we can be somewhat prudish when it comes to sexual activity for the sake of pleasure. At a certain age, many women begin to buy into the idea that it is somehow undignified or unseemly to yearn for sex.
But it’s so worthwhile to open up, find common ground, and talk about your needs. Start with a date or activity that you enjoy together. I’ve noticed that couples who see movies, read books, or even watch a weekly TV show together find more opportunity to talk about the things that are important to them. Issues that come up in books or movies can serve as great segues into your own circumstances and feelings.
If you are involved in a long-term relationship, keep in mind that your partner is changing emotionally, too, as he or she grows older. Moreover, you both may be habituated to a kind of timing or foreplay — or lack thereof — that is no longer stimulating, and you may have to do some exploring together to find out what needs to change. It may help to consult with a certified sex therapist or another counselor.
If you are going back out on the dating scene, you may feel particularly vulnerable as you sort out this different stage of your sexual self. But when you embrace how uniquely lovely you are, and trust yourself to be patient, chances are you will find a safe, loving partner willing to explore alongside you — not exploit you. I do counsel women on guidelines for safe sex in menopause. After all, you have novelty on your side in a new relationship, a chance to begin anew and reinvent yourself.
The building blocks of desire — the Women to Women approach
No matter where you are in a relationship, giving yourself permission to be a sexual, powerful, centered, communicative human being in the prime of life is wildly alluring and fulfilling — but it may not come to you overnight. It will take some self-care and attention. Here are some tips to get you started:
Embracing your new sexual self
Learning to want and love sex again is about learning to take better care of your body by tuning in to its requests for support. It’s also about letting go of your perceived limitations and welcoming a whole new range of possibilities. The world beyond menopause can be as lush and loving as you want it to be — but you have to be willing to let go of emotional baggage and vicious stereotypes about women, sexuality, and aging.
A quick look around reveals that today’s menopause is not our mothers’ menopause, and that many women are engaged in passionate sexual relationships — sometimes with men younger than themselves — throughout their lives. So take time to rediscover what you love about yourself, and allow the winds of change to gently fan the spark of your desire.
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