Nobody Warned Me Perimenopause Could Affect Sex Like This

​​​Written by Sexual Wellness Institute Owner and Therapist, Amanda Holmberg, MS LMFT

You’re in your 40’s, and recently sexual intimacy and libido just feel…different. 
Maybe your libido feels inconsistent or completely gone. Maybe sex feels less pleasurable than it used to. Maybe arousal takes longer, orgasms feel different, or touch that once felt exciting now feels neutral or overwhelming. For some women, sex even becomes uncomfortable or painful seemingly out of nowhere.
​You also might be thinking, “Nobody warned me this could happen.” And for many people, the hardest part is not knowing whether any of this is “normal.”
I am here to tell you it is! And the more informed you get on the topic of sex and perimenopause, the more in control (and hopefully better) you will feel.

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What Is Perimenopause?

First, the basics. Perimenopause is the transition leading up to menopause, when hormones begin fluctuating and changing over time. It can start years before menopause officially occurs and often begins in a person’s 40s, though it may begin earlier for some women.
Most people know about symptoms like:

• hot flashes 
• irregular periods 
• mood changes 
• sleep disruption 

But far fewer people are prepared for how strongly perimenopause can affect sexuality and intimacy.

Why Sex Can Feel So Different

Sexuality is influenced by much more than hormones alone. During perimenopause, physical, emotional, relational, and psychological factors often collide at the same time. (Sounds fantastic, I know- but remember – knowledge is power, so keep reading). 
Hormonal changes can affect:

• lubrication 
• tissue sensitivity and elasticity 
• desire 
• arousal 
• orgasm 
• energy levels 

At the same time, many women are also navigating:

• stress 
• caregiving responsibilities 
• aging parents 
• body image changes 
• demanding careers 
• relationship strain 
• anxiety or depression 
• chronic exhaustion 

When all of this happens together, it makes sense that sexuality may change, too.

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I Never Feel in the Mood Anymore

One of the most common concerns during perimenopause is decreased desire.
This can feel especially distressing for women who previously enjoyed sex or felt connected to their sexuality.
Many women begin wondering:

• What’s wrong with me?
• Am I losing attraction to my partner?
• Is this just aging?
• Will my sex drive ever come back?

In reality, desire often shifts during perimenopause rather than disappearing completely. Many women notice that desire becomes more responsive instead of spontaneous. In other words, they may not randomly feel “in the mood” out of nowhere anymore, but can still experience desire once connection, touch, relaxation, emotional closeness, or erotic stimulation begins. We call this responsive desire. This is a very different experience from the spontaneous desire many people expect sex “should” involve.

When Sex Becomes Uncomfortable or Painful

Lower estrogen levels can contribute to:

• Vaginal dryness 
• Burning or irritation 
• Discomfort with penetration 
• Pelvic floor tension 
• Tearing sensations 
• Increased sensitivity 

Unfortunately, many women assume painful sex is simply something they are supposed to tolerate during aging.
But painful sex is not something you should just silently push through. Let me repeat, you should not have to endure painful sex. There are options. 
Pain often creates a cycle:

1. Sex becomes uncomfortable 
2. Anxiety increases 
3. The body becomes more tense, can feel like it’s “guarding” against something
4. Avoidance grows 
5. Intimacy starts feeling stressful 

Over time, this can affect both relationships and self-esteem. Read here for more about how we can help with sexual pain.

Emotional Changes Matter

Perimenopause can affect more than physical functioning. Many women notice changes in:

• Confidence 
  
• Body image 
  
• Emotional regulation 
  
• Stress tolerance 
  
• Feelings of attractiveness or desirability 
  

When someone feels emotionally depleted, exhausted, overwhelmed, or disconnected from their own body, sexuality is often impacted too.
This is one reason why sexual difficulties during perimenopause are rarely “just hormonal.” Emotional well-being, relationship dynamics, stress, sleep, and physical symptoms all interact together.

Medical Support for Perimenopause

At Sexual Wellness Institute, we often encourage clients to also speak with their medical provider about symptoms or concerns they may be experiencing during perimenopause.
This may include discussing:

• Hormonal changes 
  
• Vaginal dryness or pain 
  
• Sleep disruption 
  
• Medication side effects 
  
• fatigue 
  
• Mood changes 
  
• Changes in sexual functioning 
  

We believe the best support is collaborative. Addressing both the physical and emotional aspects of sexual wellbeing can help people feel more informed and supported during this transition.

You Are Not Broken

One of the biggest myths about perimenopause is that sexuality simply disappears afterward.
For many women, sexuality during midlife becomes more intentional, emotionally connected, and authentic over time. But it often requires adaptation.
What worked sexually at 25 may not work at 45. That does not mean your sexuality is gone.
It may mean:

• Your body needs more time 
  
• Stress affects desire more strongly 
  
• Emotional connection matters more 
  
• Your nervous system needs safety and relaxation first 
  
• Pleasure looks different from how it used to 
  

Your sexuality is allowed to evolve. While these changes can feel frustrating, they can also create space to approach intimacy differently. Many people find that exploring new forms of touch, pleasure, communication, and connection can actually deepen their sexual relationship over time. It’s not all bad!

When to Seek Support

You do not have to wait until things feel severe to seek help.
Support may help if:

• Sex has become painful 
• Desire/libido changes are affecting your relationship 
• You feel disconnected from intimacy 
• You are avoiding touch or closeness 
• You feel confused about the changes happening in your body 
• Sexual concerns are affecting your confidence 
• You need a non-judgmental place to process all of these changes

Perimenopause may change sexuality, but it does not mean intimacy, pleasure, or connection are over. Often, it is the beginning of learning what your sexuality needs now rather than what it needed decades ago.

​Sex and Relationship Therapy in Plymouth and the Twin Cities

At Sexual Wellness Institute, we provide sex therapy for individuals and couples navigating desire changes, painful sex, communication struggles, relationship stress, and intimacy concerns during perimenopause and other life transitions. To get started, simply:

1. Contact the Sexual Wellness Institute to set up your first appointment.
2. Meet with one of our skilled sex and relationship therapists for an intake appointment.
3. Move forward with joy and fulfillment in sex and relationships! ​

Other Mental Health Services in Minnesota

​In addition to sex therapy, our LGBT & polyamory friendly sex therapists provide a wide range of mental health services at our Plymouth, MN counseling office. Other services include couples therapy & marriage counseling, EFT, evidence-based couples therapy, EMDR & sexual trauma therapy, as well as teen therapy. In order to help serve the mental health needs of all those living in Minnesota, we also offer online counseling & sex therapy. We also provide a variety of helpful tips on our mental health blog. Please feel free to reach out with questions, or if you would like to schedule an appointment to begin working with a skilled sex therapist! Your sex life can be amazing. Sex therapy can be a part of that process for you.

About the Author: Minnesota Therapist Amanda Holmberg

Amanda Holmberg, MS LMFT, is a licensed marriage and family therapist, sex therapist, and AAMFT-Approved Supervisor with more than 15 years of experience specializing in sex and relationship therapy. She is the founder of Sexual Wellness Institute and Radiant Living Therapy, where she helps individuals and couples address sexual concerns, intimacy challenges, and relationship dynamics in a stigma-free and trauma-aware environment. Amanda also provides training and supervision for therapists, creating tools and resources to strengthen supervision and clinical skills for therapists. ​