Menopause Survival Guide

By Shaun Denise Biggers, MD

Posted on | By Shaun Denise Biggers, MD

Sex in Your 40s 

There is a myth that women have their best sex in their 40s. For some, that may be true, but for many women, it is the beginning of a decline in libido and in intensity of sexual response that only gets worse with menopause. As gloomy as this sounds, there are some things that can be done.

A topical estrogen cream or gel can reduce the vaginal dryness that occurs with menopause and change an atrophic vagina to that of a 30-year-old’s in a matter of weeks. Only low levels of this get into the bloodstream so that many of the risks of systemic hormone use are not associated with the typical use of FDA-approved vaginal estrogen creams. 

Testosterone is the libido hormone. It is what makes us want to have sex. Unfortunately, there is not a consistent body of data showing that supplementing testosterone dependably increases libido for most women. More research needs to be done, but testosterone is often used with traditional hormone replacement therapy and has been found to be effective in increasing libido is some women. 

Arousal can be initiated or heightened by a variety of topical sexual arousal creams. Most of these creams are a mixture of some herbal extracts or oils that together cause an increase in the local blood flow to the area where the cream is applied. Most of these creams are applied to the clitoral hood and external labia. The most common ingredients in these creams are: 

  1. L-arginine, an amino acid found to increase blood flow to cutaneous skin  
  2. Peppermint oil
  3. Menthol

There are also personal lubricants that include these ingredients. The combination of these usually produces a cooling or tingling effect that may help initiate sexual arousal. These are not FDA regulated but are not known to have any long-term side effects. At worst, they could cause some local irritation (test it on your skin before putting it on your genitalia).

The most important thing for helping your libido is actually having sex itself. Most women still have satisfying orgasms even when their libido has decreased. If using these stimulants increases the frequency of having sex, then that is a good thing! 

Article written by Shaun Denise Biggers, MD