Effective Treatment for Midlife Sexual Problems

While the number of potential causes of sexual problems during menopause can seem overwhelming, there are just as many strategies and treatments for overcoming them. These include self-help measures you can adopt on your own, counseling with or without your partner, and prescription therapies or resources that your healthcare provider can direct you to. And these interventions, when properly used, have been shown to be both safe and effective in young, old, and all ages in between.

Treatment for many sexual problems often combines medications or devices with counseling (sex therapy) and/or self-help measures. Rarely does one problem have a single solution that won’t benefit from other treatments or actions. It’s also not uncommon for a woman to experience more than one type of sexual dysfunction, and therapies often overlap among various sexual problems.

This post is organized according to therapies and takes care to identify the problems that each therapy may address. If you’re looking for an overview of therapy options according to each specific sexual problem, check out the table below, which summarizes options in that way.

Therapies often overlap among various sexual problems.

Keep in mind that most sexual problems warrant treatment only if they prove bothersome to you or your partner. If neither you nor your relationship is troubled by your problem, taking no action may be the most appropriate course at this time. 

Overview of available therapies for sexual problems*

Low libido/low sexual desire

  • First and foremost, examine your relationship and situation: 
    What are the turnoffs? How can they be addressed?
  • Identify medications that may curb desire (such as certain antidepressants or blood pressure drugs) and talk with your provider about lowering the dose or switching to alternatives
  • Sex therapy/counseling
  • Certain testosterone-containing products (not government-approved for treating low desire in women)
  • Bupropion (not government-approved for treating low desire)
  • Yoga

Vaginal dryness/atrophy

  • Regular sexual activity or stimulation (promotes vaginal health and blood flow)
  • Vaginal lubricants (for temporary relief of dryness before and during sex)
  • Vaginal moisturizers (for longer-term relief from dryness)
  • Low-dose vaginal estrogen therapy in cream, ring, or vaginal tablet form (reverses underlying atrophy and dryness)
  • Higher-dose hormone therapy throughout the body via pills, patches, and other preparations (reverses underlying atrophy and dryness, but generally reserved for women with bothersome hot flashes)

Arousal difficulties

  • Topical treatments for vaginal dryness/atrophy (see above)
  • Vibrator or other mechanical devices (eg, clitoral therapy device)
  • Sex therapy/counseling
  • Bupropion (not government-approved for treating arousal difficulties)
  • Viagra-like drugs (PDE-5 inhibitors) to increase blood flow to the clitoris (not government-approved for treating female arousal difficulties)
  • Yoga

Orgasm difficulties

  • Sex therapy/counseling
  • Yoga

Pain during sex

A variety of therapies are available depending on the source of the pain:

  • Vaginal moisturizers, lubricants.  If pain doesn’t improve, see your provider.
  • Vaginal estrogen
  • Sex therapy/counseling
  • Vaginal dilators
  • Pelvic floor physical therapy
  • Kegel exercises
  • Symptom-specific medications (eg, steroid creams for vaginal inflammation, antibiotic creams or pills for vaginal infections)
  • Yoga


*In addition to the listed therapies and actions, all sexual problems are likely to benefit from good health habits
(including exercise, eating right, and adequate sleep) and open communication with your partner.

For more information go to: www.menopause.org

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