‘Sexopause’: What happens to women’s sexual desire during menopause

In 2024, middle-aged women’s sexuality has taken centerstage in the movie industry. Various projects feature mature leads having adventures with much younger men, a formula the world is more accustomed to seeing in reverse, with older men often in the driver’s seat of such May-December tales. Fall brings with it even more releases along these lines, like Babygirl, an erotic thriller in which Nicole Kidman plays a successful CEO who embarks on a secret affair with her young intern. In I Want Your Sex, Olivia Wilde brings to life an artist who turns a fresh-faced man into her sexual muse. Such films are far from the first in which mature women have delivered sexual content to the big screen, but one of the scenes in Babygirl, in which Kidman masturbates after having sex with her partner, stands out for the way it spotlights the workings of post-youth feminine desire. The actress herself has acknowledged that, though sex scenes have always formed part of her career, she’s never acted in a role quite as revealing. Such steps forward when it comes to cinematic narrative are important because, says Laura Cámara, a gynecologist and obstetrician, sexologist and expert in sexual and reproductive health, “sexuality and pleasure are related to potency, youth and many times, fertility. After all of that, it seems that women no longer have the right to be sexual or desirable or to feel desire. We have a lot of work to do.”

But it’s not just feminine desire that is coming out of the closet of late. So too is the subject of menopause, and with it, a debate surrounding sexuality at a certain stage of life. In her Spanish-language book Sexopausia (Vergara, 2024), Cámara offers a close-up, positive view of sex during menopause, looking to diffuse taboos and contemplate a woman’s pleasure as her right, not to mention a primary element of one’s quality of life. In speaking about sex during menopause, it’s important to begin with the fact that hormonal changes can affect the lived experience of one’s sexuality — but as the educator clarifies, it’s important to challenge the idea that these changes are necessarily for the worse. “With Sexopausia, I try to explain that sexuality is going to change throughout one’s life, but that doesn’t mean that it disappears. Adapting to these changes is fundamental,” she says.

For the gynecologist Marimer Pérez, who talks about health and menopause on social media with her half million followers, it’s crucial that we pay attention to physiological context when it comes to looking for solutions to problems that show up in new life stages. “The cessation of ovarian activity will result in a decrease in estrogen, progesterone and androgens. Although it seems that progesterone has a secondary role in sexual desire, the other hormones do have an impact. Estrogens help to lubricate and their decrease is linked to a decrease in neurotransmitters, which are essential to desire. As serotonin and dopamine (which are linked to pleasure) decrease, it will be difficult to find pleasure in everyday life and therefore, in sex. This scenario affects daily life at the sexual level. A decrease in estrogen is linked to a decrease in lubrication and to the famous vaginal atrophy,” she says. Pérez does not believe in treating the problem with pharmaceuticals, given that this lack of desire is due to several factors. However, she does see space for other kinds of solutions.

“It’s important to care for one’s genitals. In the same way that women have skincare routines, they need to administer to their intimate area. Ask your gynecologist whether you should be practicing genital moisturizing. Sexual desire is important, but dryness and lubrication are also key in our day-to-day lives. There are a lot of options in this area and it is important to provide solutions and convince women that a simple routine can help them to disconnect. Apply ova internally, put local estrogens in the vagina (I always recommend doing this at night, along with another type of hydration via oil or ova) and remember that this basic hydration is essential to having pain-free sex. Hormone therapy has to be on the table. You have to be able to rest and control both hot flashes and mood alterations to have good sex,” she tells EL PAÍS.

In the United States, bioidentical testosterone pellet therapy has become popular to treat flagging desire due to unbalanced hormones. “This is a controversial subject. Among women with no other problems, who are in relationships, it can be useful. But the pellet has been marketed as “the youth chip,” says Pérez, who notes that such treatments have not been approved by the European Medicines Agency. Bioidentical hormones are extracted from plants like soy and yams, and the implants are placed through a small subcutaneous incision, in areas of the body that has adipose tissue.

Active sexuality is key to quality of life, and as Cámara explains, many studies have linked pleasure and sexual activity to health improvements. “That is not exclusive to women. But let me clarify, when we say ‘active sexuality,’ we usually imagine a sexuality that we consider ‘normal,’ traditionally, that takes place within a couple. Sexuality is a very broad concept that can serve as a bridge between eroticism and pleasure that needs to be revindicated. Sexual pleasure needs to be approached differently so that we can continue to have a pleasurable sex life at all ages,” she says.

Ana Lombardía, an expert in sexual health and wellness from the sex toy company Womanizer, thinks that feeling desire, arousal and orgasms improves one’s mood and triggers the release of hormones related to well-being and happiness. “Sexual arousal helps to keep the genitals active, prevents atrophy, promotes lubrication and elasticity in the area … on the other hand, the latest study sponsored by the Womanizer Pleasure Fund on menopause suggests that masturbation can be beneficial because it alleviates certain symptoms, so it’s a good idea to try to introduce that practice during this stage of life,” she says.

Another towering taboo surrounds andropause, a reality that many men face, especially by the time they reach their fifties. In our patriarchal culture, it is not common for men to talk openly about challenges they are facing, particularly when their sex life is involved. However, difficulties in intimacy can be an opportunity for a couple to renegotiate their sexuality. “You have to achieve an intimacy as a couple that allows you to talk about what is really going on. In consultations, I ask my patients what their husband’s erections are like, because they may not be the same as before. We have to take the blame off of women and try to put the focus instead on menopause. Perhaps more foreplay is needed, and for the couple not to expect relations to take place in X amount of time, when their bodies no longer have the same hormonal levels and may need to go slower. This is part of a having good communication. Let’s not medicalize a process that requires a long-term navigation to understand what is happening and how to communicate about it,” says Pérez, who says that female Viagra seems perverse to her. “Female Viagra is dark, because it means taking a pill even if you don’t feel like it so that you can satisfy your partner. The emphasis should instead be on the long-term,” she says, in agreement with author Anna Freixas, whose doesn’t hesitate in her book Nuestra menopausia (Our menopause, Capitán Swing Libros, 2024) to invite women to liberate themselves from sex if they’re not enjoying it, and to adapt practices geared not to other people’s pleasure, but towards what makes their own body feel good.

Common discourse around menopause seems to hold that it is normal to feel discomfort during sex after a certain age, something that Cámara vehemently denies as being true. “It is never normal to feel discomfort during sex at any age. But pain is normalized at certain times of life, such as when one is just beginning to have sex, during menopause or after childbirth. It’s just not the case. It is never normal to feel pain. And it is always necessary to check up on what may be going on,” she says. To conclude, Pérez returns to the importance of communication. “It’s important to understand that this is a physiological situation and there is a series of steps that can be taken. You have to start with good dialogue, understand that one’s partner will have a certain degree of discomfort because he or she doesn’t understand why their partner isn’t always in the mood,” she says.

“Does anyone know or care if middle-aged women are getting any sexual satisfaction?” asked Emma Thompson in an article she wrote for Vogue upon the release of the movie Good Luck To You, Leo Grande!, in which she stars as a woman who, at 63 years of age, has never had an orgasm, leading her to hire the services of a 28-year-old man. It would seem that the moment to ask such a question has arrived at last, as well as the one in which we understand that although sex changes throughout the various stages of our lives, forgoing pleasure need never be the way forward. “Menopause is a new phase in which there are many changes, including those related to sexuality. If we learn to adapt to them and take advantage of them, we can experience a rebirth of our sex life that may surprise us,” says Lombardía.

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