Psychosexual issues are quite common and can affect individuals at any age. Symptoms may appear or worsen during menopause due to biological, emotional, and social factors. According to the NATSAL 3 survey, up to 40% of respondents reported experiencing sexual problems, however, only 10% of those individuals felt distressed or concerned about their situation. These issues become more problematic when they interfere with daily life satisfaction or disrupt significant intimate relationships.
There are many reasons why psychosexual difficulties occur during menopause including:
Hormonal Changes:
- Estrogen Decline: One of the primary factors is the drop in estrogen levels, which may lead to vaginal dryness, thinning of vaginal tissues, and discomfort during sex. This can result in pain (dyspareunia) and a resulting decrease in sexual desire.
- Testosterone Decline: Testosterone is present in lower levels in women, but is still an important hormone for females. Testosterone decreases with age and this may influence libido and sexual response.
Physical Symptoms:
- Hot flushes, night sweats, and sleep disturbances can reduce energy and mood, which may lower sexual interest.
- Some women experience weight gain, fatigue, or body image concerns, which can affect self-confidence and sexual desire.
- Continence issues may worsen which can cause anxiety when engaging in sexual activity. As we age our muscle tone weakens. Pelvic floor exercises can improve this but always seek advice if your continence issues are affecting your enjoyment of life.
Emotional and Psychological Factors:
- Anxiety and Depression: Menopause is often accompanied by emotional challenges, including mood swings, irritability, or depressive symptoms. These psychological states can lessen sexual desire or contribute to issues like lack of arousal and inability to orgasm.
- Relationship Changes: Long-term relationships can also undergo shifts, particularly if both partners are ageing or if menopause brings emotional strain. Communication problems or differing sexual needs can create tension.
For women who had psychosexual issues e.g., low libido, or body image concerns, before menopause, the onset of menopause may exacerbate these difficulties. Also, some women may feel pressure or stigma around ageing and sexuality, which can complicate their sexual self-image. Menopause may also increase the risk of certain medical conditions, like heart disease, diabetes, or pelvic organ prolapse, and this can also affect sexual function and overall well-being.
