Many women experience low libido and vaginal dryness during menopause, which can make sexual intercourse the last thing you are interested in. But sexual pleasure is actually beneficial for your body and mind and shouldn’t be overlooked. Oregon Health and Science University provides a list of the benefits of a healthy sexual life, and they are pretty eye opening: Lower blood pressure Better immune system Better heart health, possibly including lower risk for heart disease Improved self-esteem Decreased depression and anxiety Increased libido Immediate, natural pain relief Better sleep Increased intimacy and closeness to a sexual partner Overall stress reduction, both physiologically and mentally Dr. Arianna Sholes-Douglas is a leading women’s health practitioner, and an expert in women’s menopausal health and vaginal rejuvenation. We compiled her best advice and recommendations for women experiencing loss of libido and other sexual wellness issues. What is giving you low libido? There are so many factors to consider when thinking of a low libido. It can be a decrease of estrogen, causing the tissues on your labia and vagina to become thinner, which can make it more difficult for your body to respond to sexual intercourse. Plus, there are other things that can affect your libido during menopause. Women are being hit with so many things at once: anxiety, depression, mood swings, family dynamics, deaths of older family members, and children going through puberty or moving out of the home. With all of that to consider, it is no wonder that it can be difficult for a woman to get excited about sexual intercourse. Why is your vagina dry? When it comes to vaginal dryness, once again, it is the decrease of estrogen that interrupts women’s pleasure. Vaginal dryness can make sexual intercourse very uncomfortable. When estrogen is in decline, the tissue of the labia and vagina become thinner, which in turn can also make the vagina much drier. And an uncomfortable, dry vagina will lead to a low libido. Another thing to keep in mind, is that if you avoid sexual intercourse, your vagina will become shorter and narrower, making sexual intercourse even harder on the body in the future. Why Libido Drops During Perimenopause & Menopause Libido often shifts gradually during perimenopause and menopause due to hormonal changes. As estrogen declines, blood flow to the vaginal tissues decreases, which can reduce natural lubrication, sensitivity, and overall comfort during intimacy. Testosterone also plays a role in sexual desire, and its levels may decline in midlife as well. Together, these hormonal changes can make arousal slower and intercourse less pleasurable, naturally lowering interest in sex. However, hormones are only part of the picture. Sleep disruption from night sweats, increased stress, mood changes, body image concerns, relationship dynamics, and emotional load can all impact desire. If sex becomes uncomfortable or associated with pain, the body may begin to avoid it, creating a cycle of decreased interest. The key takeaway is that low libido during perimenopause and menopause is common — but it’s multifactorial, and there are supportive options available to address both the physical and emotional components. What can help?When it comes to vaginal dryness, it’s important to understand that this is primarily a hormonal and tissue health issue—not just a lubrication issue. While lubricants can offer temporary relief, they do not address the underlying cause.*A more effective, stepwise approach focuses on restoring the health of the vaginal tissue itself: 1. First-line therapy: Vaginal Estrogen * Local vaginal estrogen is the gold standard for treating vaginal dryness. It works by restoring vaginal pH, improving blood flow, increasing natural lubrication, and rebuilding thickness and elasticity of the vaginal lining. This requires a doctor’s prescription. Importantly, the historical black box warning on estrogen has been reconsidered, and current evidence supports the safety of low-dose vaginal estrogen for most women. Studies have even demonstrated that many breast cancer patients, in collaboration with their oncology teams, are safely using vaginal estrogen for symptom relief due to its minimal systemic absorption.2. DHEA (Prasterone – Intrarosa) *Vaginal DHEA is converted locally into estrogen and androgens within the vaginal tissue. It improves lubrication, tissue integrity, and sexual comfort without significant systemic absorption. This requires a doctor’s prescription. 3. Compounded vaginal formulations *These may include estradiol, testosterone, and hyaluronic acid. These formulations can be tailored to support both tissue health and sexual function. This requires a doctor’s prescription. 4. Non-hormonal support: Hyaluronic acid suppositories Products like this can improve hydration, reduce dryness, and provide a supportive alternative.If you want to go further, procedural options can be considered:*- Radiofrequency-based treatments (e.g., Emfemme 360) - Fractional C02 Laser therapy (e.g., MonaLisa Touch) - PRP (O-Shot), which is not standard of care but may offer benefit in select patients Some other things to try: Kegel exercises: Dr. Arianna shares that this exercise makes the pelvic floor stronger for sexual function, climax and incontinence. Don’t overlook using this exercise everyday. It definitely makes a difference. Contract your pelvic floor muscles and hold the contraction for five seconds. Then, slowly release for five seconds. Work up to repeating this move 10 times, 3 times a day. Consider sexual vibrators: Dr. Arianna not only believes in women having a holistic approach to their bodies, but also wants women to realize that they need to do whatever they can while their body is changing to adjust the pleasure factor, and sometimes that includes the use of a vibrator. There are many discreet online options, if you find a visit to a sexual aid/adult store out of your comfort zone. What if you aren’t ready for this step, or it’s more of a mental thing? Try sexual meditations! Erotic breathwork and meditations Who would have thought you could get sexual wellness through meditation? Maybe you need to calm your mind to get in the mood. Quiet practices like this with your partner or by yourself can help set the mood and get you in deeper touch with your desire. You can find options like this on apps like Dipsea. If It Feels More Mental or Emotional… Sexual Empowerment School/Counselor Another option is to sit down with a sexual empowerment counselor who can help with discussing and understanding your sexual needs. Sometimes it’s difficult to voice those to your partner, let alone a stranger. But something like this can really get to the heart of what you want - and need - in order to have a fulfilling sex life. Try storytelling. Maybe pornography is not the thing that catches your fancy. That is ok. Today, there are options for everyone. Why not try a story? There are companies, like Dipsea, that offer an app where you can basically choose your own sexual adventure. Choose from sexual audio stories, immersive pillow talks, intimate wellness guides, and sleep stories and sounds. Instead of putting you to sleep, an app could help get you in the mood! We are all different, but this is about taking time for pleasure. We Are All Different—Take Your Time With Pleasure Every woman is different and will have different concerns with her sexual experience during peri/menopause. As we always share, it’s very important to take note of your symptoms. It is the same with your sexual experience during peri/menopause. Take note of the changes and discuss them with your partner and your doctor to figure out what might work best for you. As with all things in life, YOU are your own best advocate. The same goes for making sure that your sexual experience is enjoyable for you. You deserve a healthy, fulfilling sex life! Arianna Sholes-Douglas, MD, FACOG has dedicated much of her career to helping women through the stages of life that are largely neglected by most of the medical community: menopause and perimenopause. She is board certified in Obstetrics and Gynecology and Maternal-Fetal Medicine and has been practicing medicine for three decades. She is the author of the best-selling book, The Menopause Myth: What your mother, doctor and friends haven’t shared about life after 35. *The information found in this blog shall not be considered medical advice and is being provided for information purposes only. It is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider should you have any questions or concerns. Blog Updated on: April 9, 2026
