Libido check: desire, pain or capacity?

Reduced sexual desire in the menopause transition is usually one of three distinct problems: falling desire itself, pain that makes sex something to avoid, or exhaustion that flattens everything. They are treated differently, and treating the wrong one is the most common reason nothing improves. Pain is the most treatable of the three and the most frequently reported as low libido instead.

Almost every consultation about low libido in midlife turns out to be about one or more of three things, and working out which before the appointment changes what you are offered.

Desire is the initiating interest. Pain suppresses desire entirely rationally — nobody seeks out something that hurts. Capacity is exhaustion, low mood and having nothing left. A conversation that starts with low libido tends to get a hormonal answer even when the actual problem is pain or sleep.

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Sources

• The Menopause Society — patient education
• NICE NG23 — Menopause: diagnosis and management
• ACOG — The menopause years

Other self-checks