Navigating Female Sexuality in Midlife Requires Provider Nuance and Patient Advocacy

A decrease in libido is one of the many changes that occur during perimenopause and menopause and can be caused by hormonal fluctuations and stress, according to James Simon, M.D., clinical professor at George Washington University School of Medicine in Washington, D.C., and medical director of IntimMedicine Specialists, and Andrea Donsky, RHN, nutritionist, menopause educator, researcher and co-founder of Morphus, a holistic menopause and perimenopause wellness company.

They recently co-authored ‘Women’s Sexual Health: Understanding Libido Changes During Perimenopause and Menopause,’ an abstract recently presented at The Menopause Society’s annual meeting.

The basis of the abstract was a 10-question survey, where more than 1,200 women between the ages of 45 and 59 answered questions about their relationships and any changes in libido they have noticed. The latest results of this ongoing survey show that 91% of women reported a notable decrease in sexual desire and 66% reported a decrease in the ability to reach orgasm during partnered sex.

Simon and Donsky recently sat down with Managed Healthcare Executive to discuss why libido can change, what women should do if they feel they are not being heard by their provider, and the important nuance to the advice to continue with sex when desire is absent.

One of the top contributors to a lack of sex drive is a drop in the sex hormone testosterone that occurs during midlife for women. When combined with the stresses caused by caring for aging parents, sending children to college and financial strain, the drop in libido starts to make more sense, Simon explained.

“There are also other hormones that can come into play,” Donsky said in an interview with Managed Healthcare Executive. “For example, when we go into perimenopause and menopause, things like our thyroid [levels] might shift, and we know one of the major side effects of a hypothyroid is lack of sexual desire, so making sure that our doctors look at everything is important.”

The survey also revealed that among women who shared their concerns about libido, 22.3% were told to still engage in sex, regardless of drive.

“Spontaneous sexual thoughts and fantasies are much more common in younger women than they are in older or menopausal women, but responsive desire, or reactive desire, is still present in many of those women,” Simon said during a recent video interview. “So, it may not be terrible advice to recommend that they try and experience engagement in sexual behavior to see if that will trigger responsive desire. To find out if responsive desire is latent in that woman is very important, because it may become her new normal.”

However, this advice may be misconstrued as dismissive, so it is essential that an in-depth conversation take place during a doctor’s visit, specifically one that touches on responsive desire, Simon explained.

If a woman ever feels dismissed by a provider during an appointment, it’s important for the patient to challenge them and even change providers, if need be.

“Don't be afraid to challenge that person… you're just commenting about how you feel in your body,” Simon said. “Sometimes the practitioner is going to be right, sometimes the patient's going to be right, but the patient is the customer, and on some level, the customer is always right.”