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Intimacy issues are common at menopause. A doctor explains how to solve them

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Intimacy issues can be a lonely road. We tend to keep problems in this area to ourselves, not realising that many others are also suffering in silence.

What’s “normal”? Let me reassure you that most women will experience sexual problems at menopause. In that sense, abnormal is actually… normal!

For example:

  • 75% of menopausal report problems with vaginal lubrication.
  • 28% report pain with intercourse.
  • 15% have vaginal itching, irritation or pain.
  • Women are 2-3 times more likely than men to experience reduced libido as we age.
  • In 1/3 of couples, male sexual dysfunction is the primary issue. Causes include medications, mood disorders and erectile dysfunction.

Sex in Queensland: A companion report to The Australian and New Zealand Journal of Public Health 2003, Volume 27, Number 2.

These figures are a little old, but the most frequently reported sexual issues in women aged 50-59 were:

  • Lack of interest in sex (2/3)
  • Inability to orgasm (almost half), and
  • Equal third place were vaginal dryness and body image issues (about 1/3).

These seem like big problems right? Well, they can be, if you let them. But remember, these issues are NORMAL at midlife and beyond.

Once you realise that and stop worrying that there’s something wrong, you can get on with working out how to manage them. So here it is, my special gift to you, dear readers:

Dr Kelly’s Deeply Insightful Solutions For The Commonest Sexual Problems At Menopause

Lack of interest in sex over 40 is normal…only a problem if you fail to realise it and change your approach (more on that below).

  1. Lack of interest in sex over 40 is… NORMAL. Only a problem if you fail to realise it and change your approach (more on that below).
  2. Difficulty orgasming. Also normal, but often unacceptable. Again a change of approach is required here, which can be tricky in a long-term relationship with very set routines and habits, but not impossible. Explore alternative means of stimulation, such as manual, oral or mechanical. The deep vibrations produced by some vibrators can really help speed up arousal and orgasm in postmenopausal women.
  3. Vaginal dryness can often be very successfully relieved with vaginal estrogen or testosterone and lubricants. Check out our resources below.
  4. Body image. Find your inner goddess (and/ or a more appreciative partner!). The table above proves that gorgeous young women are even more insecure than you, so clearly being young and gorgeous doesn’t solve the problem. Find what you/ your partner love most about your body and celebrate it. ShoulderFest perhaps? Break out the tank tops…

What Physical Changes Contribute To Sexual Problems At Menopause?

  • Less estrogen results in lower vaginal blood flow and lubrication, tissue thinning
  • Vaginal tissues are drier and more prone to pain and damage
  • Less acidic vagina, more prone to infection
  • Ageing=lower testosterone=reduction in sex drive and responsiveness
  • Hot flushes and mood changes make us feel tired, irritable, anxious or depressed… not sexy!

What Psychosocial Factors Are Contributing to Sexual Problems At Menopause?

  • Quality of relationship with partner
  • Grief/loss: children leaving home, ageing or dying parents
  • Prior levels of sexual satisfaction
  • Emotional wellbeing
  • Stress, eg. work, family dysfunction
  • Past trauma, or guilt/shame about sex
  • Poor body image

What Other Factors Might Be Contributing?

  • Poor general health
  • Chronic pain or diseases
  • Thyroid problems
  • Menstrual problems, PMS
  • Other conditions causing painful sex, like endometriosis, prolapse, infections
  • Medications: particularly antidepressants

What’s Up With My Libido?

This depends on what you mean by “libido”.

Which of these applies most to you?

  • I don’t feel like initiating or agreeing to sex much, but I can enjoy it once we get into it, and perhaps even orgasm.
  • I don’t enjoy sex at all: it’s painful/traumatic/upsetting. I can’t get excited, lubricated or orgasm.

These are very different situations demanding a very different approach. I recommend you read Dr Rosie King’s wonderful book Where did my libido go? for a full rundown of the different categories of libido issues and their possible solutions.

The second situation does require investigation and management by a doctor and/or therapist.

The first, however, is very manageable if a couple is committed to communicating and working together to improve things.

Excerpts from Jean Hailes’ excellent “Libido” factsheet:


  • Maintain a healthy lifestyle: physical activity, a healthy diet, reduce your alcohol intake.
  • Find ways to reduce stress and take time out to relax regularly.


  • Create goodwill and some intimacy between you and your partner, by talking, listening and touching and holding each other, so you are more likely to feel sexual towards each other.
  • Don’t wait for sex to happen spontaneously—allocate time for sex.
  • Create a physical environment for sensuality and intimacy.


  • Let your partner know what makes you feel loved and encourage them to do these things and do the same for them in return.
  • Work with your partner as a team to deal with libido issues—if there is desire discrepancy try to find a compromise agreeable to both of you.
  • Communicate what works best for you during sex—your partner may not know what you like.

Options. If you have low desire but still enjoy sex, try:

  • ‘Decision-driven’ sex rather than waiting to have ‘desire-driven’ sex—you make some decisions by saying to yourself: “Sex is good for our relationship, so even though I can’t be bothered, I will suggest making love tonight”.
  • Sex for affection or intimacy or because sex is good for your relationship or because you enjoy sex.
  • Manual or oral stimulation rather than intercourse.
  • Realise that sex is not only penetrative intercourse but includes touching, kissing, holding, trusting and/or oral stimulation. Talk about this with your partner. Take it in turns to make love to the other with no expectations.


  • Rather than automatically saying no to sex when the opportunity arises, ask yourself “why not?”—if no good reason presents itself, give sex a try.
  • Optimise the quality of sex you are having with your partner—the better the sex, the more likely you are to want it.
  • Explore your own sexuality—get to know your sexual anatomy, learn how things work and what gives you pleasure.
  • Where do you like to be touched, what sort of pressure, can you bring yourself to orgasm? If you don’t know, how can your partner know?
  • Nothing gives most men more pleasure than seeing their partner enjoy sex. When together, focus on your own pleasure—stay present and enjoy.
  • Chronic or long-term, low libido can create differences in sexual desire in couples. Sometimes, your partner can fear hurting you (physically and emotionally) and this starts a negative cycle in your sexual relationship.


Dr Kelly Teagle is a GP and menopause expert in Canberra and founder of WellFemme, a ground-breaking Telehealth menopause clinic.


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