Menopause alone does not end desire or pleasure; dryness and pain are treatable, and relationship quality and attitudes toward aging matter a great deal.
“After menopause, everything is over.” Many women, from Tehran to Toronto, have heard this sentence and gradually said it to themselves.
No; the data do not say that. In the long-term SWAN study, entering the early menopause transition did not reduce desire, arousal or sexual satisfaction; only pain during intercourse was reported more often. Vaginal dryness becomes more common over time — across 17 years of follow-up it rose from 19.4% to 34.0% — but it is treatable. Relationship quality and a woman’s attitude toward aging are tied to sexual pleasure more than entering the transition itself.
What does menopause do to desire and sexual pleasure?
In the SWAN data, entering the menopause transition did not by itself lower desire or satisfaction; what increased was pain during intercourse. This picture, however, concerns only the early transition years, not the decade after menopause.
In the baseline analysis of SWAN (Avis et al., 2018; PMID: 30358720), 3,167 women aged 42 to 52 were examined (premenopausal or early perimenopausal, not using hormones). Women in early perimenopause reported more pain during intercourse (P = 0.01), but frequency, desire, arousal, and physical and emotional satisfaction did not differ from premenopausal women. Four factors were most associated across outcomes: relationship quality, the importance she places on sex, her attitude toward aging, and vaginal dryness.
A woman by the window at dawn; the menopause transition begins with questions about the body and desire — Photo: cottonbro studio / Pexels
This analysis is a snapshot and does not prove causality; women over 52 and women using hormones were not included. This article’s position is clear: “menopause” should not replace a diagnosis. If desire or pleasure has dropped, a specific cause should be sought, not an age label.
How common are dryness and pain, and why should they not be endured?
Vaginal dryness increases as the menopause transition advances: in a 17-year study, its prevalence rose from 19.4% to 34.0%. It is a physical and treatable symptom, and the pain is not fate.
Waetjen et al. (2018; PMID: 29916947) followed 2,435 women from 1996 to 2013 in SWAN; dryness prevalence rose from 19.4% at the start (age 42 to 53) to 34.0% at the thirteenth visit (age 57 to 69). Progression of menopause stage, surgical menopause, anxiety, and marriage were associated with onset. Dryness and lubricant use were linked to later pain during intercourse, but not with decreased frequency. Many couples continued sex despite pain; this is an interpretation [needs further verification: how much was consensual]. The data are self-reported and observational.
The systematic review by Mili et al. (2021; PMID: 33739315) of 27 studies reported a prevalence of 13% to 87% for symptoms linked to the genitourinary syndrome of menopause, such as dryness, irritation, itching and painful intercourse. This wide range shows that definitions and study populations were not uniform (this too is an interpretation). More consistent was that vaginal health is rarely raised at a medical visit and that most women with symptoms were not satisfied with the treatment they had used.
What evidence supports treatment for dryness and pain?
A systematic review of 46 trials suggests that some hormonal products and vaginal moisturizers may reduce dryness and pain in the short term; but certainty is low and long-term data are scarce.
Danan et al. (Annals of Internal Medicine, 2024; PMID: 39250810) reviewed randomized trials of at least eight weeks in menopausal women. Most of the 46 trials tested hormonal products and only four tested vaginal moisturizers. Some options may improve dryness and pain during intercourse (low certainty of evidence); most trials were 12 weeks or shorter and long-term data are limited. Serious side effects were not commonly reported, but the studies lacked power to detect rare ones [needs further verification: long-term safety].
The choice of product rests with a gynecologist and depends on each woman’s medical history. In the Mili review, moisturizers and lubricants were among the most used self-care options (24.0% to 85.5%), but they do not replace medical evaluation for persistent pain.
Low desire, relationship, and mind: where is the psychological part?
Low desire is the most common sexual problem in women, peaking in midlife, but its roots are not solely hormonal: illness, depression, relationship dissatisfaction, and a history of abuse are also risk factors.
Kingsberg (2015; PMID: 25569014), in a review, writes that diagnosis of a desire disorder depends on the woman’s own distress; low desire that does not cause distress is not a disorder.
From a psychoanalytic view, Freud in “Mourning and Melancholia” (1917; Standard Edition, vol. 14, pp. 237–258) sees mourning as a reaction to loss of an object or an abstract substitute. That loss of fertility and a younger body may be a quiet mourning found in low desire is a clinical generalization, not an experimental finding [needs further verification].
Based on clinicians’ experience, a repeating pattern appears: a woman considers pain “the share of age” and hides it, and the partner interprets her silence as low desire or rejection; the two build opposing emotional narratives about one physical event. This is a clinical observation, not a study result.
For Iranian women, from Tehran to Toronto, saying these things is often not easy. A cross-sectional, self-report study in 2026 of 299 women with a refugee background in Australia (Jahangirifar et al.; PMID: 40773295) found sexual difficulty at 39.3%, and menopause or perimenopause was associated with it (odds ratio 2.8; 95% CI: 1.4 to 5.6). This is not an Iranian population, so the result cannot be generalized to Iranians.
Does sexual desire necessarily decrease after menopause?
Not necessarily. In the SWAN analysis (PMID: 30358720), desire in early perimenopausal women did not differ from premenopausal women; Kingsberg (PMID: 25569014) considers low desire common in midlife, with depression, illness, and relationship dissatisfaction as factors.
How common is vaginal dryness?
In the 17-year follow-up of SWAN women, dryness prevalence rose from 19.4% to 34.0% (PMID: 29916947). A review of 27 studies reported a prevalence of 13% to 87% for symptoms linked to the genitourinary syndrome of menopause, such as dryness and painful intercourse (PMID: 33739315).
Should pain during intercourse be endured?
No. Pain is a known consequence of dryness (PMID: 29916947), and some medical treatments and moisturizers may reduce it, though certainty of evidence is low (PMID: 39250810). Discuss persistent pain with a gynecologist.
When should I see a specialist?
When pain continues, low desire distresses you, or it has created distance with your partner. Kingsberg (PMID: 25569014) stresses that personal distress is the diagnostic criterion; gynecological evaluation and mental-health conversation can proceed together.
Conclusion: Midlife can be a new chapter of intimacy
The sentence that can replace “it is over” is: “My body has changed, and this change has a name and a solution.” Two practical steps follow from the data: tell a gynecologist about the physical symptom and begin a conversation with your partner openly; in clinical experience, many women who come through this transition arrive at a calmer, more aware relationship. That is a clinical observation, not a finding of the studies above.
Looking for professional support with your relationship or mental health?
Avis NE et al. Correlates of sexual function among multi-ethnic middle-aged women: results from the Study of Women’s Health Across the Nation (SWAN). Menopause. 2018. PMID: 30358720. DOI: 10.1097/GME.0000000000001226
Waetjen LE et al. Factors associated with developing vaginal dryness symptoms in women transitioning through menopause: a longitudinal study. Menopause. 2018. PMID: 29916947. DOI: 10.1097/GME.0000000000001130
Mili E et al. Genitourinary syndrome of menopause: a systematic review on prevalence and treatment. Menopause. 2021. PMID: 33739315
Danan ER et al. Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause: A Systematic Review. Annals of Internal Medicine. 2024. PMID: 39250810. DOI: 10.7326/ANNALS-24-00610
Kingsberg SA et al. Female sexual dysfunction: focus on low desire. Obstetrics & Gynecology. 2015. PMID: 25569014. DOI: 10.1097/AOG.0000000000000620
Jahangirifar M et al. Sexual difficulties, distress and dysfunction among women with refugee background in Australia. Climacteric. 2026. PMID: 40773295. DOI: 10.1080/13697137.2025.2537973
Freud S. Mourning and Melancholia (1917). The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 14, pp. 237–258.
Image Credits: Photo: Attila Šimko / Pexels (featured image) · Photo: cottonbro studio / Pexels
