Similar to psychological function, beliefs regarding sexuality after menopause are often based on myth and common misperceptions. The majority of women, up to 70 percent, experience satisfying sexual relations after menopause. Often, an understanding of the changes that occur naturally at this time and the possible interventions are all that is needed to restore normalcy to sexual intimacy. As with other issues associated with the menopausal years, sexual function is the net result of a complex interplay of various factors.

Changes in the sexual response or arousal cycle occur in both men and women as they age. The ability to reach and achieve climax or orgasm does not change. It may take more work to get there. Women require stimulation for longer periods of time to achieve lubrication; men require more direct stimulation to achieve and maintain an erection. Hormonal changes also have a contributing role. Declining estrogen levels contribute to vaginal changes and may lead to pain with penetration. A decline in androgen levels probably contributes to a change in libido (or sexual desire) in both men and women. Women may experience androgen-related changes at an earlier age. A lack of understanding of these contributing factors can lead to anxiety and avoidance of sexual encounters. 

Responsiveness in both men and women can be affected by illness and medications. Some changes are easily reversed with treatment or medication adjustment. Changes may be permanent as a result of illness or therapy for certain conditions. Couples are often successful in redefining a satisfying intimate relationship when intercourse is no longer a component. 

Psycho-social circumstances may also effect sexual function. For some women, menopause may be a liberating experience; it can be a time of freedom from concerns of contraception, child rearing, bothersome periods and premenstrual syndrome (PMS) symptoms. The empty nest is a welcome change. However, menopause also occurs at mid-life, a time that may be overloaded with increasing obligations. Stresses at work or at home with growing children and aging parents can affect sexual function. 

What to Do: 

Partners should communicate to achieve a level of activity that is mutually satisfying.

People should be familiar with the normal changes in sexual function that occur with aging and adjust accordingly.

Regular sexual activity helps maintain vaginal integrity and lubrication.

Vaginal lubricants are available, without prescription, for the relief of vaginal dryness and painful intercourse.

One may want to consider estrogen replacement therapy for the management of symptoms related to vaginal atrophy.

One may want to consider the addition of androgen therapy to estrogen replacement in the therapy of decreased libido.

It is helpful to look at the big picture: sexual desire, or lack thereof, is the end result of many factors.