When women reach menopause, they experience shifts in their hormonal balance. For many women, this means they are less sexually interested than they used to be. Some women experience just the opposite effect, becoming more sexually aroused, though the vast majority of women are normally less motivated.
When they are involved in sexual activity though, they often warm up to the experience and are quite happy to participate. The sexual concern of women in menopause is that they have lost the enthusiasm to be the initiator and encourager. Some women find this to be very unsettling and one of the key reasons they come to me for discussion and therapy. They want to improve their situation and become more sexually interested again, for it often has relationship implications.
Part of my treatment is helping women understand that loss of sexual desire is a normal experience due to hormonal changes and not necessarily a sexual dysfunction. Though they may be unable overcome this problem constitutionally, I do help women adjust to these biological changes and better adapt to the new circumstances.
Menopausal changes also include reduced lubrication and tissue changes in the vagina that may cause pain during sexual intercourse. Application of lubricants, moisturizers or localized hormones can help ameliorate these problems and make penetrative sex more pleasurable again.
In addition to these tools, a broadened sexual repertoire that includes pleasurable, non-penetrative activities helps women and their partners have enjoyable and satisfying encounters.