I Want to Feel Like I Used to Feel'

A Qualitative Study of Causes of Low Libido in Postmenopausal Women

Holly N. Thomas, MD, MS; Megan Hamm, PhD; Rachel Hess, MD, MS; Sonya Borrero, MD, MS; Rebecca C. Thurston, PhD


Menopause. 2020;27(3):289-294. 

In This Article

Abstract and Introduction


Objective: Low libido is common among women over 60 and negatively impacts well-being and relationship satisfaction. Causes of low libido in this age group are not well understood. We used qualitative methods to explore older women's perceptions of causes of low libido.

Methods: We conducted 15 individual interviews and 3 focus groups (total N = 36) among sexually active women 60 and older who screened positive for low libido using a validated instrument. Interviews were audio-recorded, transcribed, and coded using a codebook developed by two investigators. Codes were examined, and themes related to causes of low libido emerged.

Results: Women noted a number of different factors that contributed to low libido. The common factors that women discussed included postmenopausal vaginal symptoms, erectile dysfunction in male partners, fatigue and bodily pain, life stressors, and body image concerns. Women often found ways to adapt to these factors. These adaptations required open communication between partners regarding sex, and some women noted these conversations were difficult or not successful.

Conclusions: A wide variety of factors contribute to low libido in women over 60, but many of these factors are addressable. Low libido in older women should not be automatically attributed to "normal" aging or to menopause; providers should take an approach to assessment and treatment that addresses biological, interpersonal and social, and psychological factors.

Video Summary: http://links.lww.com/MENO/A499


The majority of US women over 60 report low libido, and 10% meet criteria for sexual dysfunction.[1] While there is increasing attention on low libido in perimenopausal women, low libido in women over 60 remains understudied. Low libido can have significant negative impacts on well-being and relationship satisfaction.[2–5]

Multiple quantitative studies have examined factors that are associated with low libido in women. Stress, relationship dissatisfaction, mood symptoms, and a history of sexual trauma and violence are frequently cited.[5–7] However, studies often exclude older women. In addition, qualitative studies, which allow women to speak at length regarding their experiences using their own words, may uncover themes that have gone previously unrecognized.

Understanding the factors that contribute to low libido among older women can facilitate the development of new and more effective behavioral and biomedical treatments. A better understanding can also help providers recognize the most important factors to address when assisting a woman over 60 with sexual complaints. The aim of this study was to explore factors that contribute to low libido among sexually active women 60 and older using a qualitative approach.