Has Your Once-Smoking-Hot Sex Drive Taken a Nosedive?

If so, here's what you can do about it.

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Published December 05, 2022
an extinguished candle during the winter holidays
Margeaux Walter

Consider the cycle of sex throughout our lives. In your 20s, it’s all about sex much of the time. Then you get into the baby-making years, where sex has a purpose. Enter midlife and the bedroom is a place where all you want to do is get a decent night’s sleep. Then come our older years, when bodies change and monotony in long partnerships sets in.

It is hardly surprising that loss of libido is the most common sexual complaint I hear from my postmenopausal patients. The medical term for lack of lust is hypoactive sexual desire disorder (HSDD), which is defined as an absence of sexual thoughts, fantasies or desire for sexual activity that causes distress or interpersonal difficulties. The “causes distress” part is important. Many women tell me they have no libido. But when I ask if they want to discuss possible solutions, a lot of them say, “No, it’s fine. Not an issue for me.”

Other women tell me they feel like something has been stolen from them, and they want it back. In most cases, loss of libido is a downstream effect of other issues. Here are five common culprits that can cause what was once a healthy sex drive to take a nosedive.

1. Sex hurts like hell

Once estrogen has plummeted, up to 70 percent of women experience pain during intercourse because of vaginal dryness. Avoidance becomes the norm, and 9:30 p.m. seems like the perfect time to do a little laundry to circumvent the discomfort of slipping into bed and trying to make yourself invisible. No one wants to do something that hurts, and it is hopeless to address libido issues without first eliminating the pain. In the CLOSER (clarifying vaginal atrophy’s impact on sex and relationships) survey of over 4,000 women, 65 percent of women with vaginal dryness reported low libidos. Two-thirds rarely engaged in sex. Multiple studies have proven that treating vaginal dryness is the variable most likely to wake up libido.

2. Exhaustion

Insomnia is hardly an aphrodisiac. The solution is to figure out why you aren’t sleeping, starting with navigating ways with your doctor to get rid of those hot flashes. Restless leg syndrome and sleep apnea are also common after menopause and have a huge indirect impact on libido. In addition to plummeting hormones, add in a few midlife issues such as illness, problematic relationships, weight gain and stress to add to the tossing and turning.

3. Partner problems

Some women are simply no longer attracted to the snorer in the bed next to them. It’s common for women (and spouses) to blame a plunge in estrogen for lack of interest. While hormones do impact libido, there appears to be very little correlation between specific estrogen and testosterone levels and the desire for sexual activity. In most cases, serious partner issues seem to correlate with sexual activity more than hormone levels, which is why some women may benefit more from SRT (spouse replacement therapy) than HT (hormone therapy). But before you turn your partner in for a different model, a few sessions with a marital and relationship therapist who specializes in sexual problems might turn things around. Go to the American Association of Sexuality Educators, Counselors and Therapists website to find one.

4. Drugs

It’s also not uncommon that a drug you are taking for another medical condition can kill the desire for sex. At the top of the list are the most prescribed antidepressants, selective serotonin reuptake inhibitors (SSRIs), which are associated with lowering libido about 30 percent of the time. The reason why SSRIs lower libido is the same reason why they alleviate depression: These antidepressants work by altering the release of neurotransmitters that control mood, such as dopamine and serotonin. The problem is, dopamine and serotonin also control the pathways that determine how often we think about, and desire, sex. Lowering the dosage or switching to a different antidepressant may alleviate the problem, but this is not a do-it-yourself project. Never alter your dosage or stop an antidepressant without the help of your doctor!

5. Hormone hell

While a lack of estrogen and testosterone are not at the top of the list, they are still on the list. If sex doesn’t hurt, you are wildly attracted to your partner, and you are not taking a drug that has sabotaged your sex life, then estrogen and in some cases testosterone therapy can wake up a dead libido. Having said all this, in many cases, it is often simply the monotony of monogamy that sabotages the desire for sex. If you have cornflakes for breakfast every morning for 30 years, a chocolate chip pancake can be a welcome change. So get creative, buy that skimpy lingerie, invest in some partner vibrators, surprise him or her with an invitation for an early retreat to the candlelit bedroom instead of staying glued to the TV news. Even if the romp only results in some cuddling and kissing, the heat for firing up your libido has been turned up.

Do you suffer from a waning sex drive? Let us know in the comments below.

Lauren Streicher, MD, is a Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical school, The Feinberg School of Medicine and is the medical director of the Northwestern Medicine Center for Sexual Medicine and the Northwestern Medicine Center for Menopause in Chicago. She is the host of the hit podcast, THE Menopause Podcast, and the author of Dr. Streicher’s Inside Information Series, which includes: Slip Sliding Away: Turning Back the Clock On Your Vagina-A gynecologist’s guide to eliminating post-menopause dryness and pain, and Hot Flash Hell: A Gynecologist’s Guide to Turning Down the Heat. She is also the author of Sex Rx: Hormones, Health and Your Best Sex Ever, and The Essential Guide to Hysterectomy. Dr. Streicher is a Fellow in the American College of Obstetricians and Gynecologists, a member of the Sexual Medicine Society of North America, Inc. and is a Certified Menopause Practitioner of The North American Menopause Society. She was the 2019 recipient of the North American Menopause Society Media Award.