What’s normal? Understanding libido changes in older women

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Libido describes our sexual desire, both conscious and unconscious. This can be influenced by many factors including hormones, the brain, mood, and social elements. The urge to have sex varies vastly between different women and in many it is hard to define what is ‘normal’. Sometimes low libido can be due to specific conditions, for example due to a side effect of medication, and sometimes there may not be any apparent reason behind a change in one person’s libido. However, if a lack of sexual desire is causing distress, it is known as hypoactive sexual desire disorder (HSDD). If you are experiencing a period of low libido and it isn’t causing you any bother then it is unlikely to be HSDD.

It is difficult to know how common HSDD, or low libido, really is. We can be reluctant to admit such feelings due to embarrassment or perceived stigma. Some more mature women may wrongly worry it is undignified to discuss such issues.

There is a general perception that libido decreases with age, an issue that has been found to be more prominent in women than their male counterparts. There is a noted dip by the age of 50 that worsens by age 60. It is assumed by some that losing this desire is normal part of life. However, the truth is you are never too old to enjoy a happy and healthy sex life.

In a study that interviewed women over the age of 50, only 43% of these reported still being sexually active. Around one third reported stopping sexual activity due a lack of interest.1 But why does this happen?

Physical reasons

Unfortunately, increasing age means our chances of developing physical health problems also increase. Heart disease, diabetes, dementia, and arthritis can make physically becoming aroused or having sex a challenge. The effect is twofold. Firstly, the disease itself can cause difficulties. The pain associated with arthritis, for example, can mean the act of having sex is simply too uncomfortable. Couples may need to try alternative positions or different sexual activity if this is a problem.

Secondly, the side effects from medication can cause libido issues. Antidepressants and beta blockers are particular culprits but there are many more. Some antidepressants, called selective serotonin reuptake inhibitors (SSRIs), work by increasing a chemical in the brain called serotonin. This chemical is known to inhibit sexual desire, although scientists are still unsure of the mechanisms behind this. Common SSRIs used are citalopram, sertraline, and fluoxetine, but there are several more. SSRIs can also affect the levels of chemicals called dopamine and norepinephrine, which are also noted to have an effect on libido.

Beta blockers can affect the blood flow to the genitalia which in turn can reduce arousal. Check the drug leaflet or consult your pharmacist if you’re worried this may be an issue for you.

Hormonal changes

There are several different hormones and chemicals that can influence our urge to have sex. Dopamine, oestrogen, progesterone, and testosterone are the hormones that are thought to increase sexual desire. Serotonin, prolactin, and opioids are thought to have the opposite effect.2

Testosterone is thought to play a particularly large role in sexual desire and is known to deteriorate with age. This may be an evolutionary aspect; as the body is no longer able to reproduce, it reduces the urge to participate in reproductive activities. Treatments for this have not yet been fully investigated and unfortunately there is little currently available in the UK.

It is still debated by scientists whether the testosterone itself has a direct effect, whether it is its influence, or whether it is a product of a process called aromatisation, a chemical reaction where testosterone is transformed into oestrogen. There have been benefits noted in several studies where giving testosterone has led to increased arousal.3

Menopause

Discussion of hormones is also linked, of course, to menopause. There are further changes that occur in the period during and around the menopause. Oestrogen and progesterone levels significantly decline at this time, two hormones that are key players in sexual desire. Oestrogen normally causes the lining of the genital tissues to thicken, however in the absence of this the tissue becomes increasingly fragile and dry. Progesterone normally has a role in monitoring the menstrual cycle and pregnancy, and while the role progesterone has in sexual desire is still not fully understood, a definite link has been noted.4

The vaginal dryness and reduced desire can also be accompanied by symptoms of menopause such as hot flushes and night sweats. Although not directly related, these can influence a woman’s self esteem which can further reduce desire to have sex. Giving oestrogen as hormone replacement therapy (HRT) has been shown to improve libido, but, as with any medication, there are risks and benefits which you should discuss thoroughly with your doctor prior to taking. There are a variety of other products that can help with changes associated with the menopause: oestrogen creams, for example, can help with vaginal dryness. Pessaries and vaginal rings that secrete oestrogen are also available depending on your preference.

Love and intimacy

A considerable proportion of mature couples will have been in the same relationship for many years. Over-familiarity may mean that sex just isn’t an exciting prospect any more. Couples may appreciate the companionship aspect of the partnership more than the sexual part. Interestingly evidence shows that despite perceived sexual problems, the majority of women still reported being satisfied in the relationship.5 Others feel that sexual encounters enhance their feelings of romance and passion, and enhance their self esteem. There is no ‘one size fits all’ in this department. Couples may find that better communication and experimenting with new ways of being intimate can help. There are specific psychosexual counsellors available on the NHS and privately if this is an area you think you might want to discuss with a professional.

Mental health

Depression is a big problem in the UK and women aged 40 to 60 are known to be the most commonly affected group.6 This can have a negative effect on a woman’s libido. Symptoms can include lack of enjoyment in normal activities, feeling low or tearful, and lack of appetite. There are many treatment options available for depression. Unfortunately, certain anti-depressant medication, such as the aforementioned SSRIs, can also have a negative effect on libido, but there are other options such as counselling or therapy to consider. If you think this may be affecting you do not hesitate to make an appointment to discuss this with your GP.

Libido is widely variable between women and there are a wide range of factors that can affect this. While the physical changes that occur with age can lead to a decrease in libido, the degree of this varies between women so it is impossible to say what is ‘normal’. While hormone changes are believed to affect libido, there is no reason that age alone should prevent a healthy sex life. Speak to your doctor if you would like a personalised assessment.

References

  1. G. Kalra et al., ‘Sexuality: desire, activity and intimacy in the elderly’, Indian J Psychiatry, vol. 53, no. 4, 2011, pp. 300-306.
  2. A. H. Clayton, ‘The pathophysiology of hypoactive sexual desire disorder in women’, Int J Gynecol Obstet, vol. 110, no. 1, 2010, pp. 7-11.
  3. S. L. Davison and S. R. Davis, ‘Androgenic hormones and aging — the link with female sexual function’, Horm Behav, vol. 59, no. 5, 2011, pp. 745-753.
  4. J. R. Roney and Z. L. Simmons, ‘Hormonal predictors of sexual motivation in natural menstrual cycles’, Hormones and Behavior, vol.63, no. 4, 2013, pp. 636-45.
  5. A. D. Seftel, ‘Re: Characteristics of premenopausal and postmenopausal women with acquired, generalized hypoactive sexual desire disorder: The hypoactive sexual desire disorder registry for women’, J Urol, vol. 188, no. 2, 2012, pp. 548-9.
  6. National Centre for Health Statistics, ‘Depression in the U.S. Household Population, 2009-2012’, NCHS Data Brief, no. 172, 2014, [available online], https://www.cdc.gov/nchs/data/databriefs/db172.htm, (accessed 23 May 2017).

Dr. Sarah Merrifield MBChB

Sarah is a doctor based in West Yorkshire. After graduating from Sheffield University in 2011 she has worked in a variety of areas including general practice, gynaecology and infectious diseases. Her special interests include sexual health and medical education. Sarah is passionate about science communication and has recently won a local competition for this. Outside of a work she enjoys travelling, good food and theatre.

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