Menopause Libido and Spontaneous vs. Responsive Desire: What’s the Connection?

6 min read

Written by: Erin O'Connor

Medically reviewed by: Kara Govoni CNM, MSCP

In the past few years, we’ve made great strides when it comes to shifting attitudes around menopause. Midlife women’s health resources are more readily available, and we’re talking about menopause more openly than ever, but there’s one topic that remains taboo: female sexuality and sexual health.

40-55% of women in the menopause transition experience a loss of sex drive, which, if you take a moment to digest, is a whopping number. Now, many of us were not raised to view female sexual satisfaction as a priority, let alone a major component of our well-being. So, when menopause shepherds in symptoms of sexual dysfunction or we start experiencing painful sex, many of us don’t stop to consider that there could be an alternative.

If you couldn’t already tell, we’re here to do some serious myth-busting, and to assure you that great sex is possible during menopause. Specifically, we’re going to be breaking down the differences between two types of desire, both of which can inform our relationship to sexual activity and change over time.

Spontaneous vs responsive sexual desire

When we think about sexual desire, we often think of a sudden rush of arousal and urgent need to be intimate with a partner, or ourselves. Cue scene of a woman initiating sex with her partner who says “I don’t know what’s gotten into you, but I love it.” This is what we call spontaneous desire –– when you experience desire before intimacy has been initiated, and without planning. This desire type is what we see portrayed most often in social media, movies, and porn.

Responsive desire, on the other hand, refers to desire we feel in response to some type of initiation, like a tender touch or kissing session. Unlike spontaneous desire, which we may associate with a “spark,” responsive desire can look more like the openness to pleasure — the willingness to see where that tender touch or kissing session might go, even if we aren’t feeling super turned on right away.

Unfortunately, due to inadequate sexual education and harmful media depictions of sexuality, particularly female sexuality, many of us place a lot of weight on the former. We worry that if we plan sex, we remove the passion, that if we don’t find ourselves frequently possessed by the burning need to get down and dirty, we’ve “no longer got it.”

Emily Nagoski, sex educator and author of Come as You Are: The Surprising New Science that Will Transform Your Sex Life, refers to this mindset as the “desire imperative,” and writes about its ironic impact: “Here’s the irony of the desire imperative: does all that worry about “spark” make it easier to want and like sex? On the contrary, worry mainly puts sex further out of reach.”

This myth is harmful for everyone, in particular for women in perimenopause/postmenopause, whose experience of desire may shift as a result of hormonal changes.

Menopause and desire

During menopause, our hormone levels are shifting significantly, and so too can our interest in sex. For starters, decreasing estrogen and testosterone levels can result in genitourinary syndrome of menopause — the not-so-friendly scientific term for vaginal dryness. In fact, upwards of 30% of women experience this symptom in perimenopause, and 75% postmenopause. With decreased vaginal lubrication comes painful or uncomfortable sex, as well as weakened sexual arousal and orgasm, and let’s be real: that’s not the kind of sex anyone would want to have (or should be having).

On the other side of the same coin, we have the emotional and behavioral influences of menopause: sleep difficulties, body image issues, mental health symptoms (and to make matters more complicated, the antidepressant medications we use to address mood symptoms can sometimes cause low libido as a side effect). All of these factors can influence how we experience desire, particularly responsive desire.

The good news is (because it’s not all doom in gloom), even if you’re experiencing a decrease in spontaneous desire, responsive desire is still very much possible — we just need to find the ways to cultivate it.

What can women do?

The first step to nurturing desire in our lives is embracing the fact that there is no “normal way” to experience it. In fact, newer models of sexual response suggest that desire is more often a response to context, as opposed to a random bout of excitement. Now, this context, or stimuli, is something we can cultivate in our lives. This can look like…

Prioritizing foreplay

Kissing, cuddling, and fondling are all important in building up to sex, but sometimes we’re so concerned with the “final act” that we rush through them, or think of them just as a means to an end. Instead, try focusing on being present and finding the pleasure in these exchanges, without assigning a “next step.”

Getting to know your relationship with desire

Sexual desire is complex, with many lifestyle factors playing an important role. There isn’t a one-size-fits-all solution, so it’s important to understand your own body. Take time to consider what feels good to you and helps you feel open to desire. Perhaps it’s a run to get your endorphins going, or a nice-smelling candle to relax your senses. Elektra Clinician and Sexuality Counselor Kara Govino,CNM, MSCP often encourages patients to reframe the focus from desire to pleasure:

“The key is to put less emphasis on desire and more emphasis on pleasure. Good sex is all about seeking pleasure – the goal is to make sex enjoyable so that it can be something you can look forward to. Let go of any rules or pre-defined sexual start or end points. If something hurts, do something else. Be open and honest with what you want and focus on those things. If you make the goal of sex pleasure and not successful penetration, orgasm or spontaneous desire, you will find you will enjoy it much more!”

Establishing emotional intimacy

Whether you’ve been with your partner for ten days or ten years, emotional intimacy plays a large role in desire, especially for women. Now, this doesn’t have to mean constantly baring your soul. It can be as simple as sharing a cute story, asking your partner about their week, or even laughing together at a comedy show.

Planning ahead

Yes, plan. Nope, it’s not a bad word. Planning sex gives you a chance to set up all of the things that help you to experience desire.

What about hormone therapy?

If you’ve been working on reframing your relationship with desire and find that your sexual function or sexual interest isn’t what you’d like it to be, you may want to consider supplements and over-the-counter solutions, which we outline in detail in our full guide to libido.

And then there’s menopausal hormone therapy (previously referred to as hormone replacement therapy or HRT) to help support sexual symptoms of menopause. Local vaginal estrogen, which comes in the form of creams, moisturizers, tablets, inserts, and suppositories, is often the first line of defense for vaginal tissue dryness resulting from decreasing estrogen levels. Unlike systemic estrogen, which is absorbed throughout the body to treat things like hot flashes/night sweats, local options don’t carry the same risks since they’re designed to only be used vaginally. This is why vaginal estrogen estrogen is considered safe for most women.

There’s also testosterone therapy, which seeks to address decreased libido as a result of decreasing testosterone levels (because no, it’s NOT only a male hormone!). While testosterone hormone therapy is not yet FDA-approved, there is substantial evidence regarding its safety and efficacy, with healthcare providers increasingly prescribing topical testosterone for postmenopausal women as an effective way to improve libido via enhanced sexual mood, nipple/clitoral sensitivity, and orgasms.