Sex (After 40): How Hormones Can Boost Your Desire, Comfort & Confidence

Written By Ann Konkoly

What Every Woman Should Know About Sexual Health

It’s common for women to notice changes in sexual health during perimenopause and menopause — things like vaginal dryness, discomfort during intimacy, and a drop in libido. These changes are often linked to hormonal shifts, but here’s the good news: they are treatable.

At Kultivate Women’s Health, we follow guidance from ISSWSH (the International Society for the Study of Women’s Sexual Health) to provide safe, effective, and evidence-based options to support sexual wellbeing.

Why Sexual Health Changes in Midlife

As estrogen and testosterone decline, vaginal tissues can become thinner, less elastic, and less lubricated. This condition, called genitourinary syndrome of menopause (GSM), can cause:

  • Vaginal dryness or irritation

  • Painful intercourse (dyspareunia)

  • Recurrent urinary tract infections

  • Lower sexual desire and satisfaction

  • Urinary incontinence

The Role of Vaginal Estradiol

Vaginal estradiol is a low-dose, localized estrogen therapy that restores vaginal tissue health without significantly affecting systemic hormone levels. ISSWSH and The Menopause Society both agree it’s safe for most women, even those who cannot take systemic estrogen.

Benefits include:

  • Increased natural lubrication

  • Thicker, healthier vaginal tissue

  • Reduced pain during intercourse

  • Lower risk of recurrent UTIs

Testosterone for Women

Testosterone isn’t just for men — it plays a role in sexual desire, arousal, and orgasm intensity in women, too. In cases of low libido not explained by other factors, low-dose testosterone therapy may help.

  • ISSWSH supports its use for postmenopausal women with hypoactive sexual desire disorder (HSDD).

  • We monitor closely to ensure levels stay in the physiologic range for women.

Vella Bioscience: Intimate Support Options

Alongside medical therapies, topical products like Vella Bioscience Intimate Elixir can enhance arousal and pleasure by improving blood flow and sensitivity. While not a hormone, it can be a helpful adjunct to HRT or as a standalone option for those looking to boost sexual confidence.

The Bottom Line

Sexual health is an important part of your overall wellbeing — and it doesn’t have to decline with age. Whether it’s vaginal estradiol, low-dose testosterone, or topical enhancers like Vella Bioscience’s Intimate Elixir, you have options that are safe, effective, and tailored to your needs.

Ready to improve your sexual health?

Schedule your consultation today: www.kultivatewomenshealth.com/visit

Reference
Goldstein, I., Kim, N. N., Clayton, A. H., DeRogatis, L. R., Giraldi, A., Parish, S. J., … & Kingsberg, S. A. (2021). Hypoactive sexual desire disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review. Mayo Clinic Proceedings, 96(4), 1116–1129. https://doi.org/10.1016/j.mayocp.2020.08.024

Ann Konkoly
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