Navigating Sexual Health and Desire During Perimenopause

Abstract: Sexual health changes as we age and how women feel about that may vary, but every woman deserves to know what’s happening in her body. 

Changes in sexual health and desire are a common experience for women navigating perimenopause. 

But what exactly do those changes look like and how can they affect you, your body and your relationships? 

It’s not unusual for sexual interest to wane, and if that resonates with you, know you aren’t alone. For some women a decrease in sex drive is okay and for others a drop in their libido can be disconcerting. Additionally, some women experience physical changes such as increased vaginal dryness, which can not only be uncomfortable, but can also make intercourse painful.In the past, information on women’s health, especially regarding sexual health and perimenopause wasn’t always easy to come by. Revivele is changing that.

This article is intended to empower women to understand what is happening inside their bodies as they age. Because we believe in autonomy – it’s your body, your choice – always! 

Ready to explore more about sexual health changes during perimenopause? Read on for helpful insights! 

In this article you’ll learn: 

  1. Changes to sexual desire during perimenopause
  2. Other reasons for decreased sexual desire
  3. Increased sexual satisfaction post-menopause
  4. Women’s overall health and wellness 

Embracing diversity in sexual desire: Every woman’s experience is unique and valid

In the varied tapestry of women’s sexual experiences, it’s important to underscore that every woman’s journey is unique. Women exist on a wide spectrum of sexual desires and drives, each with its own intricacies and challenges.

There are many women who wholeheartedly enjoy sex, and have all their lives. So, when sudden changes such as experiencing pain during sex, or a decrease in sexual interest occur, it can lead to feelings of stress, frustration and confusion.

A major shift in sexual dynamics can also sometimes even evoke a sense of identity loss as women try to reconcile these new experiences with their understanding of themselves and their sexuality. For those who have always enjoyed their sexuality, they may be looking for solutions to restore their previous levels of sexual interest. 

On the other hand, there are women who have comfortably lived life with a naturally low level of sexual desire, finding contentment in their experiences of sexuality. Others, however, have struggled with the complexities of a persistent low libido. In some cases, a chronic lack of sexual desire is identified as hypoactive sexual desire disorder, a condition characterized by a reduced interest in sexual activities. 

To be clear: decreased sexual desire is not a disorder – unless the absence of sexual desire is sudden, distressing, and disruptive to your sense of self and your happiness in your daily life. In that case, you may be interested in exploring various treatment options for hypoactive sexual desire disorder. 

In the meantime, there are ways to have healthy, pleasurable sex post-menopause – and we talk about those below. 

Ultimately, it’s critical to know that your worth and desirability are not defined by external factors, or where you “think” you should be on a sexual spectrum. You deserve self-love and acceptance and to claim your own narrative of desire and pleasure. 

Changes to sexual desire during perimenopause 

During perimenopause (the precursor to menopause), estrogen levels begin decreasing at a steady rate, usually beginning between the ages of 30 and 40. 

The hormone estrogen is responsible for maintaining body temperature, keeping menstrual cycles regular, balancing hormones, controlling weight and hair growth, and more. 

The steady decrease of estrogen production within the body contributes to much of the discomfort women experience during the perimenopausal years. Some of the challenges associated with lower estrogen levels during perimenopause include weight gain, hair loss and sleep disturbances. These can be frustrating and may impact a woman’s overall well-being and quality of life.

Reduced estrogen levels not only affect our physical appearance and emotional well-being, but also have a profound impact on sexual desire, performance and pleasure. 

Changes to sexual function in the body during perimenopause 

Perimenopause can bring about noticeable changes in sexual desire, performance and pleasure due to fluctuating hormone levels. Women might experience a decrease in libido, changes in sexual response, or find that intimacy feels different than before. 

For instance, during perimenopause, women commonly experience symptoms such as: 

  • Vaginal dryness (decreased natural lubrication during sex)
  • Lack of interest in sexual activity 
  • Difficulty achieving an orgasm
Up to 45% of women who are postmenopausal describe sex as painful due to biological changes that occurred during perimenopause.


Vaginal dryness can also come with a tightening of the vaginal opening, resulting in burning and itching during intercourse, known as vaginal atrophy.

A combination of vaginal tightness and dryness can cause mild to severe pain during intercourse, and even lead to tearing or bleeding of the vagina during intercourse.

There are some other causes of pain during sex that are not related to menopause, such as vulvodynia (which is chronic pain of the vulva), and so pain during sex should always be discussed with a healthcare professional. 

When women experience any pain or discomfort during sex, even just once, it can lead to heightened stress and tension in anticipation of pain during future attempts to have sex. 

Stress and tension are the kryptonite of pleasure. Women who are afraid to have sex will likely experience more tension, more tightening of the body, and therefore more pain during sex – creating a cycle of pain and negative associations with sex. 

It’s important to be aware that there are options to manage symptoms like vaginal dryness with both short term solutions like using natural lubricants, or long-term solutions such as hormone replacement therapy (scroll down for even more strategies below). 

Perimenopausal symptoms that can also contribute to decreased sexual desire

During perimenopause, women experience changes to their appearance and emotional health, both of which can have an impact on their self-confidence and desire to be touched sexually. 

For instance, women going through perimenopause may experience: 

  • Hair growth on the upper lip
  • Hair thinning on the top of their heads
  • Increased weight around the middle of their bodies 
  • Age spots 
  • Changing hair color 
  • Hot flashes and excess perspiration 
  • Incontinence or unexpected leakages 
  • Low mood caused by decreased estrogen levels (low mood tends to lead to lower sexual desire)

It’s essential to acknowledge that although numerous changes during perimenopause stem from natural hormonal shifts, there are practical strategies to manage and even lessen their impacts.

Women have at their disposal a variety of methods to alleviate many perimenopausal symptoms, particularly those affecting sleep, diet and mood (more on this below). 

Other reasons for decreased sexual desire

Changing bodies and decreased hormone levels are not the only cause of sexual disinterest as we age. 

Health concerns, medications and substances that affect desire

Health conditions such as thyroid conditions, obesity, diabetes, and cardiovascular disease can also decrease sexual desire. 

Substances and medications that can have an impact on sexual desire include:

  • Antidepressant medications 
  • Medications for high blood pressure 
  • Medications for seizure disorders 
  • Drugs or alcohol 
  • Contraceptive drugs (during the years preceding menopause)

Sexual desire and stress

Women often experience higher levels of stress during the perimenopause years than any other time in their lives. 

There are plenty of reasons women may not be interested in having sex that have nothing to do with symptoms of menopause, and everything to do with being overwhelmed by their busy lives. 

For instance, sexual interest may be impacted by:

  • Chronic sleep deprivation
  • Depression and anxiety
  • The stress of raising a family 
  • Work and work-related burnout 
  • Being overwhelmed during child rearing years 

For some women, bedtime may be literally the only time they have to themselves.

Stress impacts sexual desire through a combination of physical and psychological responses. Physically, stress triggers the release of cortisol, a hormone that can dampen sexual arousal by diverting blood flow and energy away from the reproductive organs and towards muscles and other systems essential for immediate response. In a nutshell, the body and mind’s response to stress can temporarily prioritize immediate survival and wellbeing over sexual desire. 

Saying no to sex with your partner

If you’re not interested in having sex, then you don’t need to have sex. End of story. Except – many women feel pressured by society and their partners to say yes even when they don’t want to. 

If your partner is asking you for sex and you’re not interested, talk to them about your reasons. It can help your partner to understand what you’re experiencing if you explain what is happening in your mind and body.

Open conversations can: 

  • Help your partner understand your experience 
  • Help you both to work together in redefining what is needed for intimacy to occur 

If someone in your life is not respecting your decision to say no to sex, you can seek support and guidance from women’s crisis centres. 

Increased sexual satisfaction post-menopause

“Sexual satisfaction” may not mean having more or better orgasms – although that’s certainly possible as well under the right circumstances (which we’ll talk about below).

Sexual satisfaction for many women may mean having better sex less often, or having no sex at all. 

In many cases, women who have passed menopause (which is the one year anniversary of your final period) will experience new freedoms they didn’t have during their menstruation years. 

Menopause may also bring along new sexual freedoms, as highlighted in this article by Johns Hopkins Medicine. 

Sex after menopause may come with benefits like: 

  • No more worrying about when your next period is going to start 
  • No risk of becoming pregnant
  • An empty nest (children are gone – therefore no bedroom door interruptions when things are getting steamy with your partner) 
  • A potential “reconnection” with your spouse or partner now that you have free time – and alone time – that you may not have had during the parenting years

Intimacy without intercourse 

As we mentioned above, a decrease in sexual desire is hardly a hardship for many women. Many women who desire intimacy with a partner are not referring to sex at all, but to physical companionship. 

Intimacy as we age may look different than it did in our younger years. Many women at all ages crave intimacy in the form of: 

  • Cuddling
  • Hugging
  • Holding hands
  • Sitting near one another
  • Laying back to back in bed 

By the time women reach menopause, their male partners are likely experiencing common issues that impact male sexual health, such as erectile dysfunction, which is the persistent inability to achieve or maintain an erection.

So, during the post-menopausal years, relationships might look different – our bodies will feel different and perform differently… and that’s okay.  

Foreplay as the endgame 

Women are 2 to 3 times more likely than men to experience a decrease in sexual desire as they age.

We have, as a society, decreed “foreplay” as a necessary prelude to intercourse. And of course, it’s very important for those who want to have intercourse.

But intercourse doesn’t have to be the endgame. What if foreplay was the only play?

Aging bodies may not be equipped to sustain intercourse, let alone desire it – yet with patience and respect, foreplay can be as pleasurable as ever even as we age.

Worry less about doing things the way you used to do them, or the way you think you should be doing them, and simply discover what your changing body needs and wants.

In order to achieve orgasm despite painful and uncomfortable symptoms of perimenopause and menopause, consider these sexual practices: 

  • Massage or oral sex
  • Sensual baths
  • Manual stimulation of the clitoris by yourself or your partner 

Women’s pleasure products are on the rise as society normalizes self-stimulation as a healthy practice for women. 

There are also many women’s sexual care products available on the market designed to increase women’s comfort, such as: 

  • Creams and vaginal lubricants during sexual activity
  • Moisturizers and lotions to decrease itching or dryness of the vulva

Women’s overall health and wellness 

The most important factor in women’s health – including sexual health – is maintaining care of your body and wellness overall. 

Regular exercise, balanced meals, adequate sleep, and staying hydrated can help with lowering stress, boosting mood, decreasing vaginal dryness, and improving blood flow – all important aspects for successful sexual pleasure! 

As mentioned above, symptoms such as vaginal dryness can be treated in-the-moment with natural lubricants, or can be achieved through long-term solutions such as hormone replacement therapy to replace a woman’s estrogen levels to maintain equilibrium during perimenopause and menopause.

Dr. Kavita talks about the benefits of hormone replacement therapy (HRT) in her book Lady Parts – get the synopsis here.

Keep up to date on women’s health research with Revivele

At Revivele, we believe that every woman should be given the information they need to prioritize their health, advocate for their needs and take action to prevent the development of possible health concerns.

Not only do we keep up-to-date on the latest scientific research when it comes to women’s health, and brain health, but we have just launched our new supplement system: Essentials by Revivele. Meticulously crafted with 48 optimal ingredients, it’s designed to alleviate women’s symptoms and fortify against the risk of disease.

If you’re interested in learning more about how to maintain your health as you age, read our other blogs, which are full of helpful details, research, and woman-to-woman understanding. We’re all in this together!

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