Perimenopause and Your Sexual Self
By Amy Moran, LCPC, CST, PMH-C and Owner of Spark Chicago Therapy
Maybe sex feels different lately.
Maybe you don't want it as often. Maybe you do want it, but your body isn't cooperating in quite the same way. Maybe orgasms feel different. Maybe penetration suddenly hurts. Maybe you're exhausted, irritated, sweaty, wide awake at 3am, and wondering who exactly decided this was the appropriate moment for your partner to initiate sex.
Welcome to perimenopause.
As a Chicago Sex Therapist, I wish more women knew that perimenopause isn't just about hot flashes and weird periods. It can affect your sexual self, too. And that doesn't mean your best sexual years are behind you.
First: Your Body Is Actually Changing
During perimenopause, estrogen levels fluctuate and eventually decline. These hormonal changes can contribute to vaginal dryness, changes in arousal, painful sex, sleep disruption, and changes in sexual desire. In other words, if your sexuality suddenly feels different, you're not necessarily imagining it. But—and this is important—hormones aren't the whole story. Sexuality at midlife is influenced by everything from sleep and stress to relationships, body image, medications, caregiving responsibilities, and how interested you were in sex to begin with.
So instead of immediately asking, How do I get my old desire back?, I often encourage people to ask a different question:
What does my sexuality need now?
Stop Expecting Your 45-Year-Old Body to Have 25-Year-Old Sex
This isn't depressing. I promise. Our sexual selves are supposed to evolve. Maybe spontaneous desire used to show up out of nowhere and now you need more time to become aroused. Maybe the kind of touch you used to love doesn't work anymore. Maybe you need lube. A vibrator. More stimulation. Different stimulation. More foreplay. Less penetration.
None of that means you're failing at sex.
It means the instruction manual changed. And frankly, continuing to use an outdated instruction manual isn't particularly helpful.
Please Don't Just Push Through Pain
This deserves its own section. Decreasing estrogen during perimenopause can cause vaginal tissue to become thinner, dryer, and less elastic, which can make sexual activity uncomfortable or painful. There are treatments—including lubricants, vaginal moisturizers, and prescription options—so pain shouldn't simply become something you tolerate. If sex has started hurting, talk to your gynecologist or another menopause-informed medical provider. Painful sex often creates a very predictable cycle:
Sex hurts → you anticipate pain → your body braces → arousal becomes harder → sex hurts more → you stop wanting sex.
At that point, the problem isn't simply "low libido."
Your Sexual Self Might Actually Get Better
Here's the part we don't talk about enough. Perimenopause can also be a time when women become much less interested in performing sexuality for someone else. You may know your body better. You may care less about what you should enjoy. You may be more comfortable asking for what you want—and saying no to what you don't.
For some women, desire decreases during this transition. For others, it increases. There is no universal "normal" amount of sexual desire you are supposed to maintain. The goal isn't to preserve your sexuality exactly as it existed at 25, 30, or 35. It's to stay curious about the person you're becoming.
Don't Diagnose the Relationship Too Quickly
Changes in sex during perimenopause can easily become relationship stories:
I'm not attracted to my partner anymore.
They don't want me.
We've lost our spark.
We're becoming roommates.
Sometimes those things deserve attention. But sometimes your body is changing and neither of you has been given the vocabulary to understand what's happening.
That's where Chicago couples therapy or working with a Chicago sex therapist can help. Perimenopause doesn't have to mean losing your sexual self. It may simply mean getting reacquainted with her.
And you might actually like her better this time around.