restart your sex life: finding sexual health in menopause
6 minute read
female sexual interest/arousal disorder (fsiad) affects more than 12 per cent of women between 45 and 64. but the condition often goes undiagnosed because of sociocultural barriers and limited clinician understanding.
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how do you discuss sexual dysfunction when it’s just not something people are comfortable sharing? how can you get help or help someone you care about?
women especially face stereotypes that often keep them silent about their sexual health, says dr. lori brotto, professor in obstetrics and gynecology at the university of british columbia in vancouver and psychologist with a clinical practice that focuses on sexual health.
“the taboos definitely still linger, and there’s still stereotypes, like for midlife women, sex ends at midlife, or it ends with menopause. or if you have desire and you initiate sex, you’re promiscuous,” she says.
brotto is also the executive director of the women’s health research institute in b.c., which supports research that includes sexual health.
“my journey into women’s health has been primarily through sex research, where i was doing research many years ago using animal models of sexual dysfunction in male rats. then the approval of viagra for men led me to ask the question, what about women?”
she identified a huge unmet need to address sexual dysfunction and pivoted her focus to female sexuality in humans.
so, what about women?
the little blue pill for men transformed public and medical views, reframing erectile dysfunction as a legitimate and treatable medical condition. more than 15 years after the launch of viagra, followed by numerous other drugs for male erectile dysfunction, the little pink pill known as addyi (flibanserin) to boost female sexual desire was approved by the u.s. food and drug administration.
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the 2025 award-winning documentary, the little pink pill, explores the inequalities regarding women’s sexual health. the film takes a hard look at how medical education and healthcare institutions ignore women’s sexual needs.
brotto says that advocacy and social media have brought women’s sexual health to a growing audience of people with an appetite for change. the topic is “riding the coattails of the menopause conversation as well, where we’ve seen a lot of traction thanks to influencers on social media who are saying ‘enough is enough. we need to actually talk about menopause.’”
she acknowledges, however, the concern with non-evidence-backed recommendations and opinions posted by self-proclaimed experts reaching people online, and cautions people to speak to a healthcare provider (even if that’s not easy to do).
female sexual interest/arousal disorder (fsiad)
one condition that needs more attention is female sexual interest/arousal disorder (fsiad), previously termed hypoactive sexual desire disorder and female sexual arousal disorder. the condition encompasses a lack of or significantly reduced sexual interest or arousal that often leads to distress or relationship difficulties.
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fsiad is a prevalent condition that primarily affects menopausal, postmenopausal and older women, ranging from 7.4 per cent in women older than 65 to as high as 12.3 per cent among women between 45 and 64, according to the national center for biotechnology information.
but the reality is, fsaid is underdiagnosed because of sociocultural barriers and limited clinician understanding.
“we have inadequate training of doctors in medical schools so that most physicians don’t know how to ask questions about the basic screening questions about sexual health,” brotto explains, pointing to the need for self-advocacy for women to bring concerns forward.
problems with arousal in the context of menopause show up in a number of ways.
“it could be changes in subjective arousal, so the triggers that used to excite her are no longer working. they’re not potent in the way they used to be. there’s also a body component to reduced arousal that may be reduced genital sensations. it might be more difficulties reaching orgasm or a muted orgasm response. and with menopause in particular, the reductions in estrogen that directly contribute to changes in the vagina, the epithelium of the vagina, means less elasticity, less lubrication, more pain, more friction. so if something hurts, you’re going to have less arousal.”
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‘i’ll never feel sexual again’
most people equate menopause with hot flashes and night sweats only, but they don’t think about changes to the vagina and sex, which can impact sexual arousal and function. sadly, this can result in a spiral of negative thoughts, says brotto: “my partner will leave me unless i get aroused. i’ll never feel sexual again. everyone else is having great sex, and i’m broken.”
the knowledge gap regarding what’s actually happening in fsiad and evidence-based treatments is a problem that brotto and her colleagues are working to address. while there is growing research about genital, urinary and sexual health symptoms in menopause, that knowledge hasn’t reached the public or even healthcare providers.
thanks to a grant from the federal government’s canadian institutes of health research, the sexual health and genito-pelvic pain knowledge empowerment hub (shape) has launched to educate and provide resources on women’s sexual health and treatment.
“what we’re doing is we’re targeting two groups, healthcare providers and women who might have symptoms. we’re constantly sharing science.” the hub has partnered with the sex information and education council of canada to amplify its messaging.
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research shows that about half of all women experience some kind of sexual difficulty at one point in their lives. lack of interest in sex is by far the most common and most distressing. as well, it affects other areas of life.
“sexual health is health. sexual health is part of quality of life. sexual health matters. it impacts lots of different facets of your general health and well-being and mood and relationship satisfaction,” she emphasizes. “we have evidence-based treatments, and you shouldn’t put up with dismissal.”
addyi, for example, was recently fda-approved for postmenopausal women. as a psychologist, brotto’s research and treatment approaches are psychological interventions: mindfulness-based therapy and cognitive behavioural therapy, both proven to improve sexual arousal.
psychotherapy for fsiad: mindfulness and cognitive behavioural therapy
mindfulness, a practice of the present moment with non-judgmental awareness, has been found to regulate the stress response, improve depression and anxiety, and “improve women’s connections with their body by increasing something called interoceptive awareness, helping them manage judgment, helping them manage attention, helping them to become more aware of arousal sensations.”
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brotto has written a book on the therapy, better sex through mindfulness, that provides the mindfulness-meditation-based exercises she has used with hundreds of women over the years who have benefited in terms of increasing their sexual desire. she tells some of their stories and outlines the various reasons for sexual problems, like stress and incessant multitasking. readers can do the exercises on their own to overcome a sexual difficulty or simply to better enjoy sex. she says if you’re on a typically long waitlist for psychotherapy, start with a good book.
cognitive behavioural therapy (cbt) is also a psychological treatment like mindfulness, but the approach is different. cbt is best suited for people who have irrational beliefs about being broken or abandoned by their partner unless they get aroused.
“with cbt, you target those problematic and catastrophic beliefs. and once you do that and replace them with more balanced ways of thinking, in turn, you see changes in affect and behaviour.”
the two approaches are different, but the net outcome is improvements in sexual desire and arousal.
brotto wants to convey a message of positivity about women and aging, also highlighting the fact that for a lot of women, stopping menstruation can be liberating—especially for women who have fibroids, very heavy periods or severe premenstrual syndrome.
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“suddenly they’re like, ‘wow, i don’t have to carry that burden anymore.’ and so, for some of them, desire can actually go up post menopause. that empowering message sometimes gets lost in the shuffle.”
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