Vaginal dryness and the menopause

What is the menopause?

The menopause is when a woman’s periods stop permanently because the ovaries no longer produce oestrogen or release eggs. This may occur naturally or as a result of the ovaries being removed by surgery, or damaged by chemotherapy or radiation. A natural menopause is usually confirmed by a year of no periods.

The time before your last period, when your hormone levels are falling, is known as the ‘perimenopause’. This usually starts in the mid to late 40’s and lasts about 4 years. In the UK, the average age at which the menopause occurs naturally is 51, and it happens about 2 years earlier in smokers. If it happens before the age of 40, it is considered premature.

The start of the perimenopause is marked by changes in the menstrual cycle. These include changes the amount of time between bleeds (which may shorten or lengthen) and changes in the amount and duration of bleeding. Then periods start to be missed altogether.

Women in the perimenopause report a variety of different symptoms. These include hot flushes, night sweats, difficulty sleeping, tiredness, mood changes, memory loss, joint and muscle pain, breast tenderness, urinary incontinence, vaginal dryness, a lack of interest in sex, headache and weight gain. However, not all of these symptoms appear to be specifically related to the hormonal changes that occur during the perimenopause. For example, trouble sleeping may be due to bothersome hot flushes and night sweats, memory loss and tiredness may be due to trouble sleeping or frequent hot flushes, and a lack of interest in sex may be due vaginal dryness causing pain during sex.

Menopause symptoms usually continue for around 4 years after the last menstrual period, but in about 10% of women, they may last up to 12 years. However, every woman experiences the menopause differently. Your symptoms may be severe and distressing, or mild and short-lived, or you may have no symptoms at all. Women who have had a hysterectomy (surgical removal of the uterus/womb) can still experience menopause symptoms.

How does it affect the vagina?

Reduced oestrogen levels may cause a number of changes in the vagina, including thinning of the walls, reduced elasticity, reduced blood flow and reduced lubrication (‘wetness’). Changes in vaginal fluid promote the growth of ‘bad’ bacteria and increase the risk of both vaginal and urinary tract infections.

Vaginal symptoms as a result of these changes may include dryness, itching, discomfort and pain during or after sex (see our factsheet ‘Pain during/after sex’ for more information on this). However, these symptoms may not appear until many years after the last menstrual period.

In women, testosterone is also produced in the ovaries and it is linked to female sexual function. A lack of sexual desire (also known as a lack of ‘sex drive’ or ‘libido’) may be associated with a drop in testosterone levels. A lack of sexual desire may in turn cause a lack of sexual arousal (not feeling ‘turned on’), which may include a lack of vaginal lubrication. A lack of testosterone may be more noticeable in women who have had their ovaries removed by surgery (oo-phorectomy), as their testosterone levels suddenly fall.

Of the vaginal symptoms that occur with the menopause, a lack of lubrication during sex is often the first to be noticed. Vaginal lubrication plays an important role during sex and women are usually expected to produce a moderate amount. Women have reported that they prefer sexual intercourse to feel ‘wetter’, feel more able to orgasm when sex is wetter, and think that their partner prefers sex that feels more wet than dry.

In an American study, vaginal discomfort related to menopausal changes caused 58% of women to avoid sex, with 59% finding sex painful and 64% reporting a loss of libido. Around 30% of women and men in the study said vaginal discomfort was the reason they stopped having sex altogether.

Research conducted in the United States and Europe has shown that moderate to severe vaginal symptoms may reduce a woman’s quality of life as much as serious conditions like arthritis, asthma, chronic lung disease and irritable bowel syndrome.

However, many women don’t seek help for vaginal symptoms. And unlike the other menopause symptoms, which tend to reduce in the years following the last period,
Vaginal dryness is likely to get worse if it is not treated.

How is it diagnosed?

Your doctor can probably tell if you are perimenopausal or menopausal depending on your age, menstrual cycle and symptoms. Diagnosis may be more difficult if you are taking hormonal treatments (e.g. to treat heavy periods).

They might need to examine you. This may include examination of your external genitals or ‘vulva’, which includes the opening of the vagina, the fleshy lips surrounding this and the clitoris. They may also examine the inside of your vagina with gloved fingers and/or a speculum (a plastic instrument which is inserted into the vagina and gently widened to allow better visual examination).

Your doctor may want to do a ‘swab’ or urine test to check for infection. A ‘swab’ is where a kind of cotton bud on a long stick is rolled over the skin on the inside or the outside of the vagina to collect discharge or skin cells and then sent away to the laboratory to see what bacteria are present. They may also want do blood tests to check your hormones/general health.

If your doctor is not confident in diagnosing or treating you, or they think you require more tests, they may refer you to a gynaecologist or other specialist at your local hospital.

How is vaginal dryness treated?

Hormonal treatments

If the menopause is responsible for your lack of lubrication, you may benefit from hormone replacement therapy (HRT).

Oestrogen can be given either systemically to increase levels throughout the whole body, or vaginally to increase levels in this area only.

Systemic oestrogen will also help other menopausal symptoms such as hot flushes. If you have a uterus/womb, this should be combined with another hormone called progesterone. If you have had a hysterectomy, you can take systemic oestrogen alone. Systemic HRT can be taken orally as a tablet, inserted under the skin as an implant, or applied topically as a patch or skin gel.

Vaginal oestrogens may be more suitable if a lack of lubrication is the main issue for you, or if you are unable to take systemic HRT for medical reasons. They can also be used with systemic HRT. These preparations are inserted into the vagina and come as a pessary, ring or cream. Vaginal HRT contains low doses of oestrogen and does not need to be combined with progesterone.

Research has shown that in women using vaginal oestrogen therapy to treat vaginal discomfort, 58% found sex less painful, 41% found sex more satisfying and 29% found it improved their sex life. What’s more, 57% of men looked forward to having sex because of their partner’s vaginal oestrogen therapy.

Several studies have shown a benefit of testosterone therapy in women who have been through the menopause, but mainly in those using oestrogen. In the UK, the only licensed testosterone treatment for many years was an implant put under the skin using local anaesthetic. Testosterone gel and testosterone patches have also been used, but the patches have been withdrawn and the gel is not licensed for use in women.

Tibolone (Livial®) is often classed as a type of systemic HRT. It is a man-made steroid with similar effects to the female hormones oestrogen and progesterone as well as testosterone. It can improve menopausal symptoms and a lack of sexual desire.

It is important to remember that although HRT offers numerous health benefits, it is also associated with some risks, particularly when used systemically. Ask your doctor to discuss these with you.

Complementary and unregulated preparations

There is some evidence that complementary therapies and unregulated preparations may relieve menopause symptoms. Examples include isoflavones, black cohosh and St. John’s Wort. However, many different preparations are available, their safety is uncertain, and they may interact with other medicines.

Vaginal lubricants and moisturisers

If vaginal dryness is a problem, this may be improved with lubricants and moisturisers. These products can be used alone or in addition to vaginal oestrogen.

Vaginal lubricants are used at the time of sexual intercourse. There are many different kinds available and they can be bought over-the-counter. Some are also available on prescription. They may be water-based (e.g. KY® Jelly), silicone-based (e.g. Replens™ Silky Smooth Personal Lubricant) or oil-based (e.g. peach kernel or sweet almond oils). The oil-based products may damage the latex in condoms, and it’s important to remember this if you want to prevent a pregnancy or sexually transmitted infection (STI). Some lubricants may feel better and last longer than others, so it is worth trying the different types to see which works best for you.

Vaginal moisturisers (e.g. Replens™ MD Longer Lasting Vaginal Moisturiser) help retain moisture in the vagina. These can be applied regularly and at least 2 hours before sex. They are available over-the-counter or on prescription.

Cognitive behavioural therapy

If your menopause symptoms are affecting your mood or causing you anxiety, you may benefit from Cognitive behavioural therapy (CBT). This is a type of ‘talking therapy.’ Your doctor may be able to refer you for CBT on the NHS, or you can pay to see a therapist privately – ask your doctor if they can recommend someone locally, otherwise you can find a register of accredited CBT therapists in the UK on the British Association for Behavioural & Cognitive Psychotherapies (BABCP) website www.babcp.com and a directory of chartered psychologists, some of whom specialise in CBT, on The British Psychological Society (BPS) website www.bps.org.uk

If you are experiencing sexual problems, as a result of the menopause or otherwise, you may benefit from sex therapy (see the following section on this). Some sex therapists also offer CBT.

Sex therapy

Sex therapy is talking therapy where an individual or couple work with an experienced therapist to assess and treat their sexual and/or relationship problems. Together they will identify factors that trigger the problems and design a specific treatment programme to resolve or reduce their impact.

Sex therapy is considered highly effective in addressing the main causes and contributing factors of sexual difficulties. And it helps people to develop healthier attitudes towards sex, improve sexual intimacy, become more confident sexually, and improve communication within the relationship.

Sex therapy can also be used in combination with other forms of treatment. Your GP or another health professional on the NHS may be able to refer you for sex therapy (depending on area), or you can contact a therapist directly and pay privately. It is important to make sure that they are qualified and are registered with an appropriate professional body. You can find more information on sex therapy in our factsheets ‘Sex therapy’ and ‘How to find, choose and benefit from counselling support’
How can you help yourself?

You may be able to improve some of your menopause symptoms yourself by eating a healthy, balanced diet, maintaining a healthy weight and exercising regularly (for more information see our factsheets, ‘The Mediterranean diet’, ‘Body Mass Index (BMI)’ and ‘Physical activity’).

Finally, having sex is good for you! Sexual activity has been shown to reduce vaginal changes associated with the menopause and women who have sex report fewer vaginal symptoms than those who do not (see our factsheet on ‘Lack of sexual desire/arousal’ for self-help tips on increasing a lack of sexual desire and/or arousal).

What is the Take Home Message?

Menopause-related vaginal dryness should not mean an end to all sexual activity – effective treatments are available

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch withlocal specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.

Further reading

Download or request our factsheet ‘Explaining sexual problems to your GP’

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.

Pain during or after sex

What is it?

Pain felt during or after sex is known as dyspareunia (pronounced dys- par- eu- nia). Occasional dyspareunia is normal, with deep penetration for example. But this becomes a problem if it is felt often, stops a woman from having or enjoying sexual intercourse and/or causes her distress.

Dyspareunia is one of the most common gynaecological complaints, thought to affect between 8-22% of women. It may also be one of the most difficult gynaecological problems to assess and treat successfully.

Dyspareunia may be classed as superficial (felt in the tissues around the entrance of the vagina) or deep (felt deeper within the pelvis on penile thrusting), depending on the site of the pain. Dyspareunia may have been present from the time a woman first started having sex or it may have developed later in life.

What are the causes?

These may be physical (in the body), psychological (in the mind) or a mixture of both.

Physical causes of superficial dyspareunia include:

  • Skin conditions (e.g. allergy to the latex, plastic or spermicide in condoms, allergy to semen, eczema, Lichen sclerosus, Lichen planus)
  • Infectious conditions (e.g. frequent thrush, sexually transmitted infections, urinary tract infection)
  • Lack of lubrication (causes include a lack of sexual arousal, hormone problems, some prescription medicines and radiotherapy to the pelvis)
  • Vulvodynia (long-term burning or itching pain without obvious medical cause that affects the external genitals or ‘vulva’)
  • Interstitial cystitis (inflammation of the bladder which may cause pain in the pelvis or abdomen/tummy)
  • Structural problems causing obstruction (e.g. injury/scarring from episiotomy, trauma from giving birth or female circumcision, an abnormal hymen, a cyst or abscess)
  • Muscular problems (e.g. vaginismus – a severe tightening of the vaginal muscles during penetration)

Physical causes of deep dyspareunia include:

  • Infectious/inflammatory conditions (e.g. pelvic inflammatory disease, endometriosis, inflammation of the cervix, blockage of the fallopian tubes)
  • Structural problems (e.g. uterine fibroids or pelvic adhesions following surgery or radiotherapy)
  • Muscular problems (e.g. spasm of the pelvic floor muscles)
  • Irritable bowel syndrome
  • Lack of lubrication

Dyspareunia may also be caused by sexual position, as some allow deeper penetration than others.

Psychological issues

Regardless of the cause, if sex is painful, it is likely to cause you emotional as well as physical distress. And psychological issues, such as anxiety, relationship problems and a history of sexual abuse/violence may contribute to, or even be responsible for, the symptoms of dyspareunia.

How is it diagnosed?

Many symptoms of dyspareunia are non-specific, which means they may be caused by a number of different conditions (not all of which are included in this factsheet). It is therefore important that you see your doctor, so they can try and find out what is causing the problem and plan the best treatment approach.

Your doctor is likely to ask you about your pain, your lifestyle and any other medical and/or psychological issues. They will almost certainly need to examine you, to see you have any obvious physical cause/s for the pain. This is likely to include examination of your external genitals or ‘vulva’, which includes the opening of the vagina, the fleshy lips surrounding this and the clitoris. They may apply pressure to certain areas to see where you feel the pain. You may also need an internal examination of the inside of your vagina. Your doctor may do this with gloved fingers and/or a speculum (a plastic instrument which is inserted into the vagina and gently widened to allow better visual examination).

Your doctor may want to do a ‘swab’ or urine test to check for infection. A ‘swab’ is
where a kind of cotton bud on a long stick is rolled over the skin on the inside or the outside of the vagina to collect discharge or skin cells and then sent away to the laboratory to see what bacteria are present. They may also want do blood tests to check your hormones/general health.

If your doctor is not confident in diagnosing or treating you, or they think you require more tests, they may refer you to a gynaecologist or other specialist at your local hospital.

More about the causes and how they are treated

Skin conditions

If you are allergic to something that touches your skin, you may get localised symptoms (e.g. redness, swelling, pain and itching) in the affected area/s. But some people have more serious reactions that affect their whole body (they may develop hives, swelling, difficulty breathing and anaphylaxis, which can be life threatening).

If you have an allergy to, or are irritated by latex, plastic or spermicide, you should be able to get condoms that are less likely to cause a reaction. Ask your pharmacist for advice on this. If you are allergic to latex or spermicide, you will not be able to use a contraceptive diaphragm, as these are made of latex and should be used with a spermicide. If you have an allergy to semen, you should not get any symptoms when you use a condom.

If you have eczema as a result of allergy or irritation (contact dermatitis), you and your doctor will need to identify what may be causing the problem and remove it. Treatment usually involves topical steroid creams/ointments. Ice packs (e.g. frozen peas) applied for a short time (to cool the area not freeze it!) and antihistamines can be used to relieve the itching.

Skin conditions like Lichen sclerosus and Lichen planus may be treated with topical steroid creams/ointments. If the problem is internal, you may need steroid suppositories (inserted into the vagina). Oral treatment (tablets) may be required if the other treatments don’t work. These products should be prescribed by a doctor.

Infectious conditions

Thrush may be passed on through sexual contact or it may develop for other reasons (e.g. during pregnancy, from wearing tight clothing, from taking antibiotics, using products that cause irritation to the vagina). Antifungal treatment for thrush can be taken orally as a tablet (e.g. fluconazole/Diflucan®), applied topically as a cream (e.g. clotrimazole/Canesten® cream) or used internally as a pessary (e.g. clotrimazole/Canesten® pessary). These products are available on prescription or over-the-counter at the pharmacy. If your partner has thrush, they will need to be treated too.

The symptoms of a sexually transmitted infection (STI) vary depending on which type it is, but they may include a fever or flu-like symptoms, unusual vaginal discharge, genital itching, burning, pain or discomfort, lower abdominal/pelvic pain, swollen lymph glands, pain when passing water, pain and/or bleeding during or after sex, and bleeding between periods.

Pelvic inflammatory disease (PID) is a general term for infection of the upper genital tract, which includes the uterus/womb, fallopian tubes and ovaries. The infection (often chlamydia) is usually transmitted during sex. If it is not treated early, PID may damage the fallopian tubes, which increases the risk of ectopic pregnancy (where the pregnancy develops outside of the uterus/womb) and infertility.

If you are worried you have an STI but don’t want to see your GP, you can visit a Genito-Urinary Medicine (GUM) clinic. You can find more information on STIs and search for local GUM clinics on the Family Planning Association (FPA) website www.fpa.org.uk and the British Association for Sexual Health and HIV (BASHH) website www.bashh.org. Remember that using a condom can reduce your risk of catching an STI.

A urinary tract infection (UTI), also known as ‘cystitis’, may cause pain in the bladder area, pain when passing water, a need to pass water often, blood in the urine, urine that is dark in colour or strong smelling and a fever (38ºC or more). Your doctor can test your urine to see if you have an infection. If a UTI is mild, it may clear up within a few days without the need for antibiotics. If it is severe and/or doesn’t clear up quickly, it should be treated with antibiotics. If you suffer from frequent UTIs, you may be able to reduce these by:

  • Drinking cranberry juice or taking cranberry tablets
  • Drinking plenty of bland fluids (e.g. 3-4 pints of water, milk or weak tea) to help flush germs out of the bladder and urinary tract
  • Keeping yourself very clean ‘down below’ by using a separate flannel to wash yourself night and morning
  • Using plain water only for washing
  • Always wiping from ‘front to back’ after opening your bowels
  • Avoiding bubble baths, talcum powder, vaginal deodorants & feminine wipes
  • Avoiding having a bath every day. A shallow bath is better than a deep one and a shower is better still
  • Passing water immediately after having sex

Lack of lubrication

If a lack of sexual arousal (not feeling ‘turned on’), is responsible for your lack of lubrication, increasing the amount of foreplay and delaying penetration until you are really ‘ready’ may help increase vaginal lubrication and reduce pain with intercourse. (see our factsheet ‘Lack of sexual desire/arousal’ for more information).

Vaginal dryness is common during and after the menopause due to reduced levels of the hormone oestrogen. Oestrogen deficiency can be treated with hormone replacement therapy (HRT – see our factsheet ‘Vaginal dryness and the menopause’ for more information). Thyroid problems resulting in high or low levels of the hormone thyroxine have also been associated with lubrication problems. Thyroid problems can be treated with medication or surgery.

Some prescription medicines may reduce vaginal lubrication. Examples include oral contraceptives, some antidepressants and some medicines for treating high blood pressure. If you are worried about this, talk to your doctor as alternatives may be available.

A lack of vaginal lubrication may also be associated with psychological issues, such as relationship worries, depression, anxiety and low self-esteem. If this is the case, you may benefit from sex therapy (see the following section on this).

Vaginal dryness may be improved with lubricants and moisturisers (see our factsheet ‘Sexual problems in women’ for more information).

Vulvodynia

There are two types of vulvodynia. Unprovoked vulvodynia is where the pain occurs spontaneously (i.e. is not caused by pressure or local contact) and this can affect any part of the vulva. Provoked vulvodynia (also known as vestibulodynia) commonly occurs around the entrance to the vagina (vestibule), where the pain is caused by sexual or non-sexual touch (by sexual intercourse, inserting tampons, tight clothing, cycling etc.) Urinary tract or bowel problems, such as interstitial cystitis or irritable bowel syndrome are often associated with provoked vulvodynia.

Medical treatments include topical preparations which are applied to the affected area (e.g. steroids, lidocaine or oestrogen), injectable medications (e.g. lidocaine) and oral medications that are taken by mouth (e.g. some types of anticonvulsant and antidepressant). Pelvic floor physiotherapy or psychological/talking therapy (e.g. sex therapy) may also help (see the following sections on ‘Physiotherapy’ and ‘Sex therapy’). Surgery may be required as a last resort.

Making small changes in your life may reduce the likelihood of vulvodynia. These include:

  • Minimising pressure/friction on the vulva (e.g. sitting, cycling, horse riding)
  • Washing the vulva no more than once per day using mild soaps
  • Avoiding scented products
  • Avoiding shaving around the vulva
  • Using 100% cotton underwear
  • Using gentle washing powders/liquids
  • Avoiding wearing clothes that are too tight
  • Avoiding chlorinated pools/hot tubs (alternatively, applying petroleum jelly to the vulva before their use may provide protection from chlorine)
  • Removing wet swimming costumes and exercise clothes quickly
  • Trying to find a sexual position that is comfortable (you may be better off on top)
  • Trying a water based lubricant
  • Experimenting with different sexual positions/speeds
  • Passing water straight after intercourse
  • Trying an oral medication (tablet) for treating thrush rather than a cream/pessary

Interstitial cystitis

Also known as ‘painful bladder syndrome’, symptoms include a sudden, strong need to pass water, needing to pass water more often (night and day) and severe pain in the pelvis or abdomen/tummy. It is not caused by infection and can be difficult to treat.

Lifestyle changes are usually tried first. These include:

  • Reducing stress
  • Avoiding certain foods/drinks
  • Stopping smoking
  • Limiting fluid intake
  • Making regular trips to the toilet

Your GP or specialist can give you more information on these. If lifestyle changes don’t solve the problem, medication may be required. Some people require physiotherapy (see the following section on this), psychological/talking therapy (e.g. ‘Sex therapy’ – see the following section on this), surgery or other procedures.

Endometriosis

Endometriosis is where cells like those lining the uterus grow elsewhere in the body. These cells behave in the same way as those in the uterus and follow the menstrual cycle, so each month they build up, break down, then bleed. However, while the blood of a period can leave the uterus through the vagina, it can’t leave from anywhere else in the body. This is a long-term, debilitating condition which causes painful and/or heavy periods. It may also lead to tiredness, depression, sexual problems and infertility. It affects women and girls of childbearing age.
If your doctor thinks you may have endometriosis, he will probably refer you to a gynaecologist for further tests. The results of these tests will determine if you need medical or surgical treatment. Medical treatment usually involves pain relief and/or hormonal treatment.

Inflammation of the cervix

Also known as ‘cervicitis’, this may be caused by sensitivities, allergies or infections (often transmitted during sex). Cervicitis may not cause any symptoms, but if it is not diagnosed and treated, it can lead to other problems such as PID. The most common symptoms include vaginal discharge and bleeding after sex or between periods. Infections are usually treated with antibiotics.

Blockage of the fallopian tubes

The fallopian tubes link the ovaries to the uterus. If they are blocked an egg may not be able to pass through and fertility will be affected. Blockages may be caused by pelvic infections (e.g. PID) which are often transmitted during sex, surgery to the pelvis or abdomen, and ectopic pregnancy. Surgery may be required to treat this.
Structural problems

Structural problems causing blockage or pain may require surgery. Your doctor or specialist will be able to advise you on this.

Muscular problems

For more information on vaginismus, see out factsheet ‘Vaginismus’. Problems affecting the muscles of the pelvic floor may be best treated by a physiotherapist (see the following section on ‘Physiotherapy’).

Irritable bowel syndrome

Irritable bowel syndrome (IBS) describes a variety of unexplained symptoms relating to disturbance in the bowel. Symptoms may include abdominal pain and spasms (often relived by going to the toilet), sharp pain in the back passage, diarrhoea or constipation, swelling of the abdomen, rumbling noises and wind.

Treatment may involve lifestyle changes (e.g. IBS-friendly diet, more exercise and stress reduction), medications (e.g. antimotility agents to stop diarrhoea, laxatives to prevent constipation and antispasmodics or low dose antidepressants to stop the cramps/pain) and/or psychological/talking therapy (e.g. ‘Sex therapy’ – see the following section on this)

Psychological problems

If psychological problems are causing or contributing to your dyspareunia, they may be best treated with sex therapy (see the following section on this). However, it is important that you see your doctor so they can investigate the cause of your pain and check if you have any health problems that require medical treatment.

Physiotherapy

If your doctor thinks physiotherapy may help you, they can refer you for this on the NHS. Alternatively, you may be able to self-refer and arrange to see an NHS physiotherapist without going through your doctor (depending on area ).You can also pay to see a physiotherapist privately (check that they have experience of treating your problem, they are fully qualified, and they are registered with both a recognised professional body, such as the Chartered Society of Physiotherapy (CSP), and the Health and Care Professions Council (HCPC).

Sex therapy

Sex therapy is talking therapy where an individual or couple work with an experienced therapist to assess and treat their sexual and/or relationship problems. Together they will identify factors that trigger the problems and design a specific treatment programme to resolve or reduce their impact.
Sex therapy is considered highly effective in addressing the main causes and contributing factors of sexual difficulties. And it helps people to develop healthier attitudes towards sex, improve sexual intimacy, become more confident sexually, and improve communication within the relationship.
Sex therapy can also be used in combination with other forms of treatment. Your GP or another health professional on the NHS may be able to refer you for sex therapy (depending on area), or you can contact a therapist directly and pay privately. It is important to make sure that they are qualified and are registered with an appropriate professional body. You can find more information on sex therapy in our factsheets ‘Sex therapy’ and ‘How to find, choose and benefit from counselling support’

What is the Take Home Message?

Sex-related pain may be caused by physical and/or psychological problems – don’t ignore it, seek advice early

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.

Further reading

Download or request our factsheets ‘Problems with orgasm’ and ‘Explaining sexual problems to your GP’

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.

Lack of sexual desire and/or arousal

What are sexual desire and sexual arousal?

Sexual desire (also known as ‘sex drive’ or ‘libido’) is controlled by the brain. It is the biological, driving force that makes us think about sex and behave sexually.

Sexual arousal (being ‘turned on’) involves a number of changes in the body. These include increased blood flow to the vagina, increased vaginal lubrication, swelling of the external genitals or ‘vulva’ (including the opening of the vagina, the fleshy lips surrounding this and the clitoris), and expanding of the top of the vagina inside the body. The heart rate, breathing and blood pressure also increase.

How do these differ between men and women?

The sexual response cycle has been described as a 3-stage process in men and women: desire, arousal and orgasm. However, this may not be so straightforward in women for a number of reasons. Many women do not move through these stages in a step-wise manner (for example, some women may become sexually aroused and achieve orgasm as a result of a partner’s sexual interest, but did not feel sexual desire beforehand). And some women may not experience all the stages (for example, they may experience desire and arousal but not orgasm.)

While many women feel desire when starting a new sexual relationship or after a long separation from a partner, those in long-term relationships may not think about sex very often or feel spontaneous desire for sexual activity.
The goal of sexual activity in women may not necessarily be physical satisfaction (orgasm), but rather emotional satisfaction (a feeling of intimacy and connection with a partner). Having sex to maintain a relationship, to prevent the partner from being unfaithful, may be another motivation.

Psychological factors (in the mind) may play a major part in female sexual functioning. Examples include relationship issues, self-image, and previous negative sexual experiences.

What is a lack of sexual desire and/or arousal?

A lack of sexual desire (also known as a lack of ‘sex drive’ or ‘libido’), is a lack of interest in sexual thoughts and sexual activity. A lack of sexual arousal (not feeling ‘turned on’) is a lack of response to sexual stimulation, which is felt in the mind and/or the body. In the body this may include a lack of vaginal wetness and/or a lack of swelling, tingling or throbbing in the genital area. A lack of sexual desire and a lack of sexual arousal often occur together, and treatment of one often improves the other. For this reason, these conditions are now usually considered together.

Symptoms of a lack of sexual desire and/or arousal may include:

  • Reduced or no interest in sexual activity
  • Reduced or no sexual or erotic thoughts or fantasies
  • Not wanting to start sexual activity or respond to a partner’s attempts to start it
  • No triggering of sexual desire with sexual or erotic stimulus (read, heard or seen)
  • Reduced or no feelings of sexual excitement or pleasure during sexual activity
  • Reduced or no feeling in the genitals or other areas during sexual activity

Many women may experience a temporary reduction in sexual desire and/or arousal at some point in their lives. This is particularly common during or after pregnancy, or at times of stress, and does not usually cause too much of a problem. However, if these symptoms continue long-term, are present all or most of the time, and/or cause you distress, then you should see your doctor for advice.

What are the causes?

A lack of sexual desire and/or a lack of sexual arousal may be caused by physical problems (in the body), psychological problems (in the mind) or a mixture of both.

A lack of sexual desire and/or a lack of sexual arousal may be associated with a number of physical problems. These include diabetes, hormone deficiencies (low oestrogen or testosterone), urinary incontinence, arthritis, nerve problems (e.g. spinal cord injury, multiple sclerosis) and the effects of some prescription medicines (including some that affect mood and behavior, e.g. antidepressants, some used to treat conditions of the heart or blood vessels, e.g. antihypertensives, and some that affect the hormones, e.g. Tamoxifen and combined oral contraceptives).

A lack of sexual desire may also be associated with high blood pressure, Parkinson’s disease, dementia and schizophrenia. While a lack of sexual arousal may also be associated with disease of the arteries (atherosclerosis), thyroid problems, surgical procedures and radiotherapy to the genital area, pelvis or lower abdomen/tummy, as well as frequent urinary tract or vaginal infections and vaginal skin conditions.

Psychological issues that may cause or contribute to a lack of sexual desire and/or a lack of sexual arousal include depression, anxiety, relationship problems, sexual dysfunction in the partner, unrewarding sexual experiences, low self-esteem, negative body image and a history of sexual abuse, violence or humiliation.

How are they diagnosed?

Your doctor will probably ask you about your desire/arousal problem, your lifestyle and any other medical and/or psychological issues. They might need to examine you to see you have any obvious physical cause/s for the problem. This may include examination of your external genitals or ‘vulva’. They may also examine the inside of your vagina with gloved fingers and/or a speculum (a plastic instrument which is inserted into the vagina and gently widened to allow better visual examination).

Your doctor may want to do a ‘swab’ or urine test to check for infection. A ‘swab’ is where a kind of cotton bud on a long stick is rolled over the skin on the inside or the outside of the vagina to collect discharge or skin cells and then sent away to the laboratory to see what bacteria are present. They may also want do blood tests to check your hormones/general health.

If your doctor is not confident in diagnosing or treating you, or they think you require more tests, they may refer you to a gynaecologist or other specialist at your local hospital.

How are they treated?

If a lack of sexual desire and/or a lack of sexual arousal is caused by a medical problem, this should be treated appropriately.

You can find more information on diabetes in our factsheet ‘Sex and diabetes in women’

If reduced levels of the hormones oestrogen and/or testosterone are responsible, you may benefit from hormone replacement therapy (HRT). If vaginal dryness is a problem for you, this may be helped with a vaginal lubricant or moisturiser. You can find more information on HRT, vaginal dryness, and vaginal lubricants and moisturisers in our factsheet ‘Vaginal dryness and the menopause’.

If the effects of a prescription medication are causing the problem, your doctor may be able to reduce the dose or switch the medication.

You can find more information on urinary tract infections, vaginal infections and vaginal skin conditions in our factsheet ‘Pain during/after sex’.

Flibanserin (addyi™) is a new drug for treating low sexual desire. It has to be taken every day and should not be combined with alcohol. It was approved for use in the United States in 2015 but has not been approved for use in the UK yet. Women should always see their doctor before using this medication to ensure there are no health or medical concerns contributing to the symptoms

If psychological problems are causing or contributing to your problem, they may be best treated with sex therapy (see the following section on this). Depression, however, may need medical treatment. It is important that you see your doctor so they can investigate the cause of your problem and check if you have any health problems that require medical treatment.

How might you help yourself?

Once you have seen your doctor to find out what is causing your problem and have received treatment for this if required, you may be able to help yourself increase your sexual desire and/or arousal.

If you are willing to engage in sexual activity, it may allow you to become aroused, which in turn may make you feel desire. You are more likely to want to be sexually active again if your last experience was positive, physically and/or emotionally.

If you find sex unrewarding, this may be because you and/or your partner lacks skill or because your partner doesn’t know what you like. One of the best things you can do is tell your partner what you ’turns you on’, and where and how you like to be touched.

If you need help learning what ‘turns you on’, there are many sexual or erotic materials easily available online, including books, DVDs, vibrators, clitoral stimulators, erotic games and lingerie. If you lack sexual desire and/or arousal, you may have no interest in self-masturbation (pleasuring yourself). However, this may help you become more knowledgeable about your body, learning where and how you like to be touched.
If vaginal dryness is an issue for you, increasing the amount of foreplay and delaying penetration until you are really ‘turned on’ may help increase vaginal lubrication and make things more comfortable and enjoyable.

If your partner often ejaculates or ‘comes’ before you do, and sex usually stops at this point, you could ask them to continue to stimulate you with their hand or mouth. They will probably enjoy being able to please you.

Some women find it difficult to concentrate during sex. If this applies to you, fantasizing about something sexual may excite you and reduce any negative feelings. If you are close to orgasm, alternately tightening and relaxing your pelvic floor muscles may help you get there.

What is sex therapy?

Sex therapy is talking therapy where an individual or couple work with an experienced therapist to assess and treat their sexual and/or relationship problems. Together they will identify factors that trigger the problems and design a specific treatment programme to resolve or reduce their impact.

Sex therapy is considered highly effective in addressing the main causes and contributing factors of sexual difficulties. And it helps people to develop healthier attitudes towards sex, improve sexual intimacy, become more confident sexually, and improve communication within the relationship.

Sex therapy can also be used in combination with other forms of treatment. Your GP or another health professional on the NHS may be able to refer you for sex therapy (depending on area), or you can contact a therapist directly and pay privately. It is important to make sure that they are qualified and are registered with an appropriate professional body. You can find more information on sex therapy in our factsheets ‘Sex therapy’ and ‘How to find, choose and benefit from counselling support.’

What is the Take Home Message?

A lack of sexual desire and a lack of sexual arousal often occur together, and treatment of one often improves the other

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.

Further reading

Download or request our factsheets ‘Problems with orgasm’ and/or ‘Explaining sexual problems to your GP’

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.

Problems with orgasm

What are orgasms?

An orgasm (also called ‘coming’ or ‘climaxing’) has been described as an intense and pleasurable release of sexual tension that had built up in the earlier stages of sexual activity.

When a woman has an orgasm, her heart rate, breathing and blood pressure increase. The muscles in her feet may spasm, her genital/pelvic muscles may contract and a rash/flush may appear on her body. A small number of women ejaculate when they orgasm, where a clear fluid spurts from the glands close to the urethra (tube trough which you pass water). Orgasms are often followed by a feeling of relaxation.

However, it is important to remember that orgasms are very personal things, how they feel and how they happen varies greatly between women. They may not be an earth-moving experience for everyone and they may not happen every time a woman has sex.

In women, orgasms may occur through different sensory mechanisms, but the two most important are stimulation of the external genitals or ‘vulva’ (particularly the clitoris) and stimulation of the internal pelvic area and vaginal walls. So foreplay is important.

What are problems with orgasm?

Problems with orgasm include never having an orgasm, infrequent orgasms, delayed orgasms and a reduction in the strength of orgasmic sensations. Orgasms may also be painful. While some women don’t need to have an orgasm to enjoy sex, this may be a real issue for others and their partners.  Women who feel very aroused but do not orgasm may feel ‘nervous’ or edgy’ or experience an aching or discomfort in their pelvis.  A problem with orgasm may have always been there or it may have developed later in life.

How common are they?

Problems with orgasm are very common and may affect more than 20% of women.

How are they caused?

Orgasm problems have been associated with a number of physical and psychological factors. Physical factors relate to the body, while psychological factors relate to the mind.  Women who could orgasm in the past but now cannot, may have a medical and/or psychological problem. While those who have never had an orgasm may have a medical and/or psychological problem, or they may simply have never learnt what type and duration of stimulation they need to achieve one.

Physical factors include:

  • Diseases of the heart or blood vessels (cardiovascular disease (CVD))
  • Nerve problems (e.g. multiple sclerosis, Parkinson’s disease, spinal cord injury, those caused by diabetes)
  • Problems in the pelvis (e.g. fibroids, pelvic inflammatory disease, weak pelvic floor muscles)
  • Problems affecting the external genitals or ‘vulva’ (e.g. provoked vulvodynia)
  • Hormonal problems (e.g. low oestrogen, testosterone or thyroxine)
  • Side effect of prescription or recreational drugs (e.g. some types of antidepressant, antipsychotics, anticonvulsants, beta-blockers, cocaine, marijuana, amphetamines and heroin)
  • Drug or alcohol abuse

Psychological factors include:

  • Age
  • Education
  • Cultural background or religion
  • Negative attitude towards sex
  • Sexual abuse/violence
  • Fear of pain during sex
  • Relationship problems
  • Depression
  • Low self-esteem
  • Negative body image
  • Poor communication

Physical causes are more likely if an orgasm problem develops suddenly, while psychological causes are more common in long-term or life-long orgasm problems.

Painful orgasms may be caused by certain medical conditions or changes in body structure or function. These include painful uterine contractions occurring in the last 6 weeks of pregnancy or as a result of an ill-fitting intrauterine device (IUD), and increased tone of the pelvic floor muscles (seen in conditions which affect the nerves e.g. stroke, spinal cord injury and multiple sclerosis.)

Orgasm problems can affect women of any age. Older and younger women may have different advantages when it comes to achieving orgasm – while older women may have more sexual experience and knowledge of their own body, younger woman have more sexual desire (also known as ‘sex drive’ or ‘libido’).

Some studies suggest that women with a higher level of education are more likely to have orgasms. This may be because they are more knowledgeable about their bodies and how they work, and have greater access to information about sex and general health.

Depression may affect sexual desire and sexual arousal (feeling ‘turned on’), which may in turn affect orgasm (see our factsheet ‘Lack of sexual desire/arousal’). Anxiety may create a vicious circle where a woman does not focus on the act of sex because she’s distracted by concerns about reaching orgasm, which in turn makes her less likely to orgasm, and results in her becoming even more anxious and even less likely to orgasm.

Some women may be able to orgasm through self-masturbation (pleasuring themselves) but not with their partner. This may be due to a partner’s poor sexual technique, the partner ejaculating (‘coming’) too quickly, a lack of trust, or a lack of communication about where and how the woman likes to be touched.

How are they diagnosed?

Your doctor is likely to ask you about your orgasm problem, your lifestyle and any other medical and/or psychological issues. They will almost certainly need to examine you, to see you have any obvious physical cause/s for the problem. This is likely to include examination of your external genitals or ‘vulva’, which includes the opening of the vagina, the fleshy lips surrounding this and the clitoris. They may also need to examine the inside of your vagina with gloved fingers and/or a speculum (a plastic instrument which is inserted into the vagina and gently widened to allow better visual examination). Blood tests may be required to check for hormone or other problems.

If your doctor is not confident in diagnosing or treating you, or they think you require more tests, they may refer you to a gynaecologist or other specialist at your local hospital.

How are they treated?

At present in the UK, no medication is approved specifically for treating orgasm problems in women. If an orgasm problem is caused by a medical problem, this should be treated appropriately.

You can find more information on diabetes in our factsheet ‘Sex and diabetes in women’.

If you have weak pelvic floor muscles, increasing their strength may improve your ability to orgasm. You may be able to do this yourself with special exercises (see our factsheet ‘Kegel exercises’). If not, you may need the help of a physiotherapist. If your doctor thinks physiotherapy may help you, they can refer you for this on the NHS. Alternatively, you may be able to self-refer and arrange to see an NHS physiotherapist without going through your doctor (depending on area).You can also pay to see a physiotherapist privately (check that they have experience of treating your problem, they are fully qualified, and they are registered with both a recognised professional body, such as the Chartered Society of Physiotherapy (CSP), and the Health and Care Professions Council (HCPC).

Vulvodynia is covered in more detail in our factsheet ‘Pain during/after sex’.

If reductions in the hormones oestrogen and/or testosterone are responsible for your orgasm problem, you may benefit from hormone replacement therapy (HRT). You can find more information on HRT in our factsheet ‘Vaginal dryness and the menopause’. Thyroid problems resulting in low levels of thyroxine can be treated with medication.

Treating substance abuse should help improve the symptoms if this is causing the problem.

If an orgasm problem is caused by the side effects of a prescription medication, your doctor may be able to reduce the dose or switch the medication.

If psychological problems are causing or contributing to your orgasm problem, they may be best treated with sex therapy (see the following section on this).  Depression, however, may need medical treatment. It is important that you see your doctor so they can investigate the cause of your problem and check if you have any health problems that require medical treatment.

How might you help yourself?

Once you have seen your doctor to find out what is causing your problem and have received treatment for this if required, you may be able to improve your ability to have an orgasm yourself.

Women who find it difficult to orgasm may have no interest in self-masturbation. However, this may help them become more knowledgeable about their bodies, learning where and how they like to be touched. If you want to try helping yourself increase your sexual desire/arousal, or experiment to find out what helps you orgasm, you may find sexual or erotic materials helpful.  These are easily available online and include books, DVDs, vibrators, clitoral stimulators, erotic games and lingerie. Talking to your partner about what ‘turns you on’ and what kind of stimulation you need to orgasm may also help.

Training on masturbation has been shown to help orgasm problems, particularly in women who have had them a long time. But if you are able to achieve an orgasm on your own but not with a partner, measures to improve communication, increase trust and reduce anxiety may be more useful (see the following section on ‘Sex therapy’).

For some couples, sexual activity ends once the man has ejaculated. If you haven’t had an orgasm and still feel very aroused after your partner has come, you could ask them to continue to stimulate you with their hand or mouth. They will probably enjoy being able to please you.

Some women find it difficult to concentrate during sex. If this applies to you, fantasizing about something sexual may excite you and reduce any negative feelings. If you are close to orgasm, alternately tightening and relaxing your pelvic floor muscles may help you get there.

What is sex therapy?

Sex therapy is talking therapy where an individual or couple work with an experienced therapist to assess and treat their sexual and/or relationship problems. Together they will identify factors that trigger the problems and design a specific treatment programme to resolve or reduce their impact.

Sex therapy is considered highly effective in addressing the main causes and contributing factors of sexual difficulties. And it helps people to develop healthier attitudes towards sex, improve sexual intimacy, become more confident sexually, and improve communication within the relationship.

Sex therapy can also be used in combination with other forms of treatment. Your GP or another health professional on the NHS may be able to refer you for sex therapy (depending on area), or you can contact a therapist directly and pay privately. It is important to make sure that they are qualified and are registered with an appropriate professional body. You can find more information on sex therapy in our factsheets ‘Sex therapy’ and ‘How to find, choose and benefit from counselling support

What is the Take Home Message?

Problems with orgasm may be due to other health problems – see your doctor for advice

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk/ for information and advice on many different health and lifestyle topics.

Further reading

Download or request our factsheet ‘Explaining sexual problems to your GP

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.

Women’s Sexual Problems

What are they?

Sexual problems in women are common. They are estimated to affect around one-third of young and middle-aged women and about half of older women.

The main types include:

  • A lack of sexual desire
  • A lack of sexual arousal
  • Problems with orgasm
  • Pain during or after sex

Lack of desire and/or arousal
A lack of sexual desire (or ‘sex drive’) is often described as a loss of libido and many women can experience a variety of symptoms. A lack of sexual arousal (not feeling ‘turned on’) may result from a lack of vaginal lubrication, a relationship worry or ill health. A lack of sexual desire and a lack of sexual arousal often occur together. And treatment of one often improves the other. It is important you see your doctor to describe the symptoms you are having as there are a variety of treatments available (see our factsheet ‘Lack of sexual desire/arousal’).

Problems with orgasm
These include never having an orgasm, delayed or infrequent orgasms, and a reduction in the strength of orgasmic sensations. While some women do not need to have an orgasm to enjoy sex, this may be a real problem for others and their partners (see our factsheet ‘Problems with orgasm’).

Pain during or after sex
Some women can experience pain during sex. This may be due to reduced vaginal lubrication and insufficient foreplay before penetration. It can become a problem and stop a woman from having or enjoying sexual intimacy (see our factsheet ‘Pain during/after sex’).

How are they treated?

Treatments for sexual problems in women can be divided into those that are hormonal and those are non-hormonal. It is important to remember that relationship issues are also important and should be considered.

Non-hormonal treatments

Self-help
You may want to try helping yourself increase your desire and/or arousal, or experiment to find out what helps you orgasm or makes sex less painful. Sexual or erotic materials of all kinds are now easy to find online. These include books, DVDs, vibrators, clitoral stimulators, erotic games and lingerie.

Sex therapy
Sex therapy is talking therapy where an individual or couple work with an experienced therapist to assess and treat their sexual and/or relationship problems. Together they will identify factors that trigger the problems and design a specific treatment programme to resolve or reduce their impact.

Sex therapy is considered highly effective in addressing the main causes and contributing factors of sexual difficulties. And it helps people to develop healthier attitudes towards sex, improve sexual intimacy, become more confident sexually, and improve communication within the relationship.

Sex therapy can also be used in combination with other forms of treatment.

Your GP or another health professional on the NHS may be able to refer you for sex therapy (depending on area), or you can contact a therapist directly and pay privately. It is important to make sure that they are qualified and are registered with an appropriate professional body. You can find more information on sex therapy in our factsheets ‘Sex therapy’ and ‘How to find, choose and benefit from counselling support

Vaginal lubricants and moisturisers
If vaginal dryness is a problem this may be improved with lubricants and moisturisers.

Vaginal lubricants are used at the time of sexual intercourse. There are many different kinds available and they can be bought over-the-counter. Some are also available on prescription. They may be water-based (e.g. KY® Jelly), silicone-based (e.g. Replens™ Silky Smooth Personal Lubricant) or oil-based (e.g. peach kernel or sweet almond oils). The oil-based products may damage the latex in condoms, and it’s important to remember this if you want to prevent a pregnancy or sexually transmitted infection (STI). Some lubricants may feel better and last longer than others, so it is worth trying the different types to see which works best for you.

Vaginal moisturisers (e.g. Replens™ Longer Lasting Vaginal Moisturiser) help retain moisture in the vagina. These can be applied regularly and at least 2 hours before sex. They are available over-the-counter or on prescription.

Drug treatments
Flibanserin (addyi™) is a new drug for treating low sexual desire. It has to be taken every day and should not be combined with alcohol. It was approved for use in the United States in 2015 but has not been approved for use in the UK yet. Women should always see their doctor before using this medication to ensure there are no health or medical concerns contributing to the symptoms.

Treating other conditions such as diabetes or depression may also help improve sexual problems.

Hormonal treatments

Oestrogen
Oestrogen levels fall after the menopause and after trauma to the pituitary gland in the brain (usually the result of a head injury, subarachnoid haemorrhage or radiation to the head.) Oestrogen replacement can be given either systemically to increase levels throughout the whole body, or vaginally to increase levels in this area only.

Systemic oestrogen, which can be given by tablet, patch or skin gel, will also help other menopausal symptoms such as hot flushes. Vaginal oestrogens are inserted into the vagina and come as a tablet, ring or cream. Long-term treatment is needed, because symptoms will return if the treatment is stopped.

Testosterone
In women, testosterone is produced naturally in the ovaries and adrenal glands, and it is linked to female sexual function. A loss of sexual desire may be associated with a drop in testosterone levels. When a woman has her ovaries removed surgically (oo-phorectomy), her levels of testosterone suddenly fall.

Several studies have shown a benefit of testosterone therapy in women who have been through the menopause, but mainly in those using oestrogen. In the UK, the only licensed testosterone treatment for many years was an implant put under the skin using local anaesthetic. Testosterone gel and testosterone patches have also been used, but the patches have been withdrawn and the gel is not licensed for use in women.

Tibolone
Tibolone (Livial®) is often classed as a type of hormone replacement therapy (HRT). It is a man-made steroid with similar effects to the female hormones oestrogen and progesterone as well as testosterone. It can improve menopausal symptoms such as hot flushes and can improve lack of libido (‘sex drive’).

What next?

While women may find sexual problems difficult to talk about and very isolating, help is available. You can try to help yourself or see a sex therapist as discussed above. But if a sexual problem continues long term and is causing you distress, it is sensible to see your GP. They are trained to deal with these and can examine you for any physical problems and check your general health.

If possible, share your concerns with your partner and see if you are able to seek help together. You should be welcomed either on your own or as a couple when you ask for help from your GP, local hospital clinic or sex therapist (NHS or private).

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.

What is the Take Home Message?

Sexual problems in women may be due to physical and/or psychological causes – both should be investigated.

Further reading

Download or request our booklet ‘Sex and growing older – Women’ and/or our factsheet ‘Sex and diabetes in women’.

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.

Sex and Ageing

Sex and ageing in women

Today men and women are living longer, healthier lives. Sexual intimacy and activity is an important part of life. This fact sheet will help you with some queries that you may have.

Does sex change, as you get older?

There is a common myth that older women do not have sex. However, studies have found that over half of women aged over 50 are satisfied with their sex lives. Women’s sexual responsiveness increases with age with only slightly reduced interest and functioning in many women, except during or after illness and bereavement. Many postmenopausal women have an increased sexual responsiveness, which may be due to factors such as a reduced fear of pregnancy, no longer having to use contraceptives and the end of menstrual periods.

What changes can I expect as I get older?

Estrogen levels drop after the menopause and this may lead to painful sex as the vaginal walls become thinner and less lubricated. This can be helped by using lubricants, moisturisers or estrogen tablets, creams or pessaries which are put into the vagina (see fact sheet about vaginal dryness and the menopause). You may find that the vaginal area and breasts become less sensitive to touch, and that orgasm may take longer. You may require different stimulation than before.

Can I have good sex without intercourse?

Yes, most definitely. For men and women, sex in later years may change, but can be just as emotionally satisfying as before and perhaps more so. The importance is in learning to
communicate in a way that will lead to emotional and physical fulfilment for you.

Does illness affect sex?

Yes, it can. As people grow older they are more likely to experience disabling conditions and illnesses that may affect how they respond sexually. Arthritis, stroke, coronary disease, diabetes, Parkinson’s, surgery and the side effects of drugs can all affect how they respond. The psychological effects of illness can also have an impact on sexual function, especially if the diagnosis of a life-threatening or life-limiting illness has been made, or if the illness affects self-esteem or alters body image drastically. Illness can bring change in the structure of a couple’s relationships, as previously independent people become dependent on their partner/carer. Talk to your GP if you find that illness is preventing you from enjoying sex with your partner; they may be able to help and offer solutions or put you in touch with a therapist.

I am a widow: is it wrong to look for love again?

We all need to be loved and wanted. These needs do not diminish over time, but you may find you are seeking other forms of attachment than when you were younger. If you are looking to rekindle your love life, you may feel awkward and embarrassed. These are perfectly normal feelings, particularly if your partner had a long illness, and you may have profound feelings of guilt and betrayal.

Can I get a sexually transmitted infection after the menopause?

Unfortunately, yes you can. Sexually transmitted infections are increasing in all age groups. Therefore, it is important to consider using condoms when entering a new relationship. Also if you have worrying symptoms you should get help early rather than ‘wait and see’.

Where can you get more information?

The Sexual Advice Association is here to help. We cannot give individual medical advice, but we can answer your questions on any sexual problems and put you in touch with local specialist practitioners. We also have a number of factsheets and booklets on sexual problems and related issues for men and women that can be downloaded from our website or requested. Please feel free to email us or phone our Helpline (our contact details are at the bottom of this page).

You can also visit the NHS Choices website at www.nhs.uk for information and advice on many different health and lifestyle topics.

Further reading

Sexual Health and the Menopause. eds Tomlinson JM, Rees M, Mander T. 2005. Royal Society of Medicine Press and British Menopause Society Publications Ltd.

Donate

By donating to the Sexual Advice Association, you will know that you are helping improve the lives of people living with sexual problems. If you are interested in donating, please click here or contact us for more information (details at the bottom of this page).

Thinking About Sex Day: February 14th

Launched by the Sexual Advice Association, Thinking About Sex Day (TASD) is designed to encourage everyone to think about the physical and psychological issues surrounding sexual activity.