Attitudes outweigh hormones in preserving sexual desire

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Sexual desire, or the motivation for sex, is often associated with youth, new relationships and copious hormones. In my clinical practice, one of the most common questions I am asked by women with low libido is, "Do you think it's my hormones?" Many people believe sexual desire will never be as high in later life as it was in their youth. There is a corresponding belief that hormones, and testosterone in particular, control sexual desire, and because of testosterone's slow decline over the lifespan, the slippage of sexual desire is inevitable.

Fortunately, this question of whether it is hormones, age or other psychological and relational factors that most affect sexual desire has been the topic of several large scientific studies. These studies measured hormones, mood, relationship satisfaction and a host of other psychosocial variables to examine the question of which factors contribute most to women's sexual desire over their lifespan.

Dr. Lorraine Dennerstein's research from the University of Melbourne has shown that a woman's feelings for her partner, and her relationship satisfaction, contribute more to her sexual desire than any change in hormones with menopause. Yes, the drop in ovarian production of estrogen can lead to vaginal dryness and discomfort with penetration for some women, and painful sex will stifle most libidos, but menopause-associated hormonal changes do not immediately translate into a loss of interest in sex. In fact, other research has found the belief that sex is important, and that one will continue to be sexually active with age, is a strong predictor of ongoing sexual satisfaction. In other words, beliefs tend to trump hormones when it comes to preserving sexual pleasure over time.

Most recently, there was the publication of the third wave of the British National Survey of Sexual Attitudes and Lifestyles (Natsal). This large survey of 15,000 British residents who completed a battery of measures and provided hormone samples found that menopause, per se, did not affect sexual functioning or satisfaction. In fact, replicating Dennerstein's work from Australia, Natsal-3 found that relationship happiness, and how much a couple communicates about sex, contributed the most to sexual desire. In other words, an open communication style in which partners can express their desires, pleasures and wishes in the bedroom outweigh the negative effects of any hormone.

When looking at the waning of desire that happens with age for some, it appears the real culprit is relationship duration. For many partners in long-term relationships, the increased stability, emotional intimacy and togetherness that come with being pair-bonded for decades is accompanied by a parallel (and cruel) dwindling of passion and desire.

But before you risk concluding the trade-off for a rewarding long-term relationship is forgone desire, remember that sexual desire can be cultivated by the very things that triggered it early in your relationship: novelty, mystery, intrigue and creativity. Couples who introduce novelty into their sex lives and weave in mystery and anticipation report stronger sex drives and more satisfying encounters, regardless of how many decades they have been together. Esther Perel's bestselling book, Mating in Captivity, is a must-read for those interested in this paradox and for pondering ways to introduce novelty into the relationship space where there are no more unknowns.

So what does this mean for menopausal women who have experienced a drop in sexual desire?

• Before you ask your doctor about a testosterone cream (bearing in mind that this is not approved for sexual dysfunction in North America) or the little pink pill, Addyi (which is not yet approved in Canada, has noted side effects and cannot be taken with alcohol), consider focusing on the quality of your sexual encounters. Sometimes a woman’s loss of desire for sex is more about a loss of desire for the sex she is having!
• Try to recall what efforts you put into making sex fun, creative and novel at earlier stages of your relationship, and consider introducing some of those aspects into your current sexual repertoire.
• Regardless of how long you have been in your relationship, ease with sexual communication may not be easy. Start by becoming aware of your own pleasure and the kinds of stimulation that create arousal and pleasure. Then work on communicating these observations to your partner. Some women benefit from role-playing this (in a mirror) ahead of time.
• If sexual encounters have become anxiety-provoking because of the belief that “nothing works” and you find yourself avoiding sex but wanting to work on it, consider seeing a skilled sex therapist who can teach you about “sensate focus” – a structured touching exercise that is designed to reduce anxiety, make partners aware of the sensations associated with different kinds of touch and improve sex-related communication.

Watch Perel's TEDx Talk on "The secret to desire in a long-term relationship."

Lori Brotto is an associate professor of gynecology at the University of British Columbia and a registered psychologist. Follow her on Twitter @DrLoriBrotto.