By Drs. Tristi Muir and Catherine Hansen

Meet Susan, a 56-year-old professional who’s finally come to terms with her hot flashes, night sweats and insomnia and made peace with her mood swings. At a visit to our clinic, she declares, “My libido has completely disappeared.”

Susan’s not joking and she’s not alone. Every day, women at all stages of life get up enough nerve to book an appointment. Some drag along a faltering, speculative, yet willing partner, while others arrive cautiously unaccompanied.

For each, there is a different answer to the hide-and-seek game of where is my libido, but there are some underlying principles to consider.

Sexual desire, once thought to be spontaneous, unplanned and at-the-ready, is now understood to be far more complex and multifaceted, especially for women and even more so for menopausal women.

Susan is having trouble buying into the new and creative ways her husband suggests spicing up their 30-year marriage. She’s not particularly interested in exploring her body, researching her erogenous zones or expressing her wants and needs openly to her husband. She must learn and practice all of this if she wants her relationship to mature and change successfully. 

Susan and her husband are dealing with age- and hormone-related changes in both of their bodies and minds. However, these changes can be negotiated with openness, playfulness and resourcefulness.

Susan feels like her plate is full with work, kids in college and the possibility of her mother moving in with them. She can’t recall the last time she had a “date night.” 

Foreplay has become an elbow in the gut when she’s just about to fall asleep at night. Their sex life, which has never needed more than 20 minutes of attention per episode, must now become the focus of research, dialogue, innovation and imagination.

We review all aspects of Susan’s sex life during her visit. Does she ever have the spontaneous urge to rush home after work, get naked and jump into bed with her husband, neglecting all domestic responsibilities?  Sounds like fun, but is it realistic? 

Perhaps as newlyweds and before kids or career progression, but now, with arthritis, back pain, erectile difficulties, fatigue, menopausal moodiness and a receding retirement date, it’s not likely that she’ll break the speed limit to get home for sex.

Does Susan still find her husband attractive? What does she love about him? Does she feel sexy in her own skin? When they do have sex, is it enjoyable? 

Many women enter sexual playtime from a neutral sexual drive but a strong motivation for intimacy, closeness and commitment and can genuinely view sex as an expression of love. For some, climax is important. For others, pleasure comes from feeling relaxed and connected.

Susan’s capacity to locate her lost libido will be in direct proportion to the time and energy she devotes to the quest. 

She’s asked to schedule “couple time” with her husband to explore their bodies and challenge long-standing, pre-conceived expectations for their sexuality. 

The journey will not be quick or easy. But imagine what this new intimacy will do for the quality of their relationship.

Our Bodies, Our Lives focuses on issues surrounding women's sexual, gynecological and emotional health.
Drs. Tristi Muir and Catherine Hansen are gynecologists at the University of Texas Medical Branch at Galveston. Learn more at