Let’s face it—sex is an issue in middle age. Many women give up on it altogether,” writes British- Australian actor Naomi Watts in her bestselling 2025 book, Dare I Say It, which lays bare her experience with early menopause. In a chapter dedicated entirely to sex and relationships saucily titled ‘Vag of Honour’, Watts describes something many womenare familiar with: low libido. “While many of us find our libido plummeting in middle age, some people find themselves able to embrace a new form of sexuality that feels good for them, because they know themselves, and they lose the awkwardness of youth,” she writes.
Although celebrities are increasingly vocal about the uncomfortable shifts many women experience during menopause, sex drive remains one of the last taboos. Perhaps it’s because no one really knows how much sex everyone is having, and there’s a natural tendency tothink they’re having more. What’s more, experts agree there’s no ‘normal’ level of sexual desire and low libido itself isn’t quantifiable.
There are statistics, however. According to a 2022 Flinders University study of more than 20,000 Australians aged between 16 and 69, a whopping 52 per cent of women reported a lack of interest in sex, versus just 28 per cent of men. “We’ve been measuring women’s sexuality against a male template for a hundred years,” says Melbourne-based GP and the founder of The Menopause Clinic, Dr Fatima Khan. “When a woman doesn’t think about sex spontaneously the way her partner does, she’s told her libido is broken. It isn’t broken, it’s wired differently.” For years, Khan has seen a steady stream of patients in her Victorian clinics who present a type of sex drive common to women that’s known as ‘responsive desire’. This means they experience cravings for sex only once they’re physically intimate. “So a desire emerges after arousal begins, meaning you need to be in an environment where the [sexual] thoughts are there and you physically have some arousal and then you want to have sex,” says Khan.
By contrast, she says 70 to 80 per cent of men experience spontaneous desire. “Generally speaking, for men, sexual desire is context-resistant, meaning your environment or your surroundings don’t impact it,” she says. “They will just have this drive which comes out of the blue.” As psychologist and relationship counsellor May Soo puts it, “You feel horny: that’s what you call spontaneous.” For many others, there’s a laundry list of biological and environmental mood-killers that make getting in the right headspace for sex increasingly challenging. Medications including selective serotonin reuptake inhibitors (SSRIs), painkillers, the contraceptive pill, beta-blockers and even antihistamines, as well as chronic conditions like arthritis and depression, can lower libido.
Then there’s the other M-word, menopause, which can be the first time many women recognise a slump in sex drive. “I guess women don’t go up to a doctor saying, ‘I have low libido’ because there’s so much happening in that 40 to 50 [age bracket],” says Khan. “What women are actually presenting with originally is the signs of perimenopause. So sleep disturbance, mood disturbance, fatigue, and then you’ve got the environmental stresses of full-time careers, young kids and caregiving. So libido is sometimes the last thing to talk about.” Low libido is most often a by-product of another concern, explains endocrinologist Dr Steven Morris. “As an isolated single problem, it’s unusual,” he says. “It’s often a sign or a pointer of something else happening.” Nevertheless, its prevalence is hard to ignore. According to a study published in The Journal of Sexual Medicine, among Australian women aged 40 to 65, almost 70 per cent report low sexual desire and nearly a third meet the criteria for hypoactive sexual desire dysfunction, a disorder characterised by a persistent lack of interest in sex.
Numbers like these are what have driven researchers at Monash University to better understand women’s hormones, sexual health and the role naturally occurring hormones like oestrogen and testosterone play when it comes to sexual wellbeing. While oestrogen plummets once women stop having periods, testosterone—which is produced primarily by the ovaries and adrenal glands—peaks in women in their 20s, then slowly starts to wane. “By 35, it’s pretty low and by menopause, you only have half the amount that you had in your 20s,” says Khan. “The most vulnerable time for couples is this transition to perimenopause for women, because wehave a biological transition happening with fluctuating oestrogen, declining testosterone, and then you have the mental load and the demands of life.”
Taking into account individual circumstances, doctors may, in some cases, consider hormone-based treatments. However, experts emphasise this is only one part of a complex picture. “Anecdotally, I’ve got women with very low testosterone and they have really high desire [for sex],” Khan says, “and we have women with excellent testosterone levels—top of the range—who have very poor libido and, despite replacing testosterone, they continue to have low libido because we can’t just address the biological mechanisms for women; we’ve got to address the psychology aspect of it as well. It’s not a magic wand. It works best aspart of a comprehensive approach, and only when the evidence supports its use.”
Fashion designer Pip Edwards was just 39 when she had a hot flush while watching her son’s basketball game. Despite experiencing symptoms including night sweats, interrupted sleep and body aches for months, the P.E Nation co-founder was shocked to learn she’d entered perimenopause before her 40th birthday. Edwards is now an advocate for women’s reproductive health and a shareholder in the menopause supplement company Biolae. “One thing I’ve realised through becoming involved is that women have become very good at quietly tolerating things they shouldn’t have to,” she says. “We’ve become more comfortable talking about symptoms like hot flushes and sleep, but symptoms that impact intimacy, libido and vaginal health can still feel much harder to discuss, despite often having a huge impact on confidence, relationships and quality of life. Each woman’s experience is unique and personal. Whilst I havehad some of the common menopause symptoms, I actually haven’t personally experienced a drop in libido.” Hormonal shifts aside, it’s normal for sex drives to seesaw, especially in long-term relationships. About half the couples Soo sees at her Sydney clinic are navigating a common issue known as desire discrepancy, meaning the sex drive of two people in a relationship has become misaligned. “Who has matching bookends when it comes to sex? Every person is different. I think if we’re waiting to meet someone with almost matching libidos, we’re going to be waiting forever,” says Soo. “The mismatch is inevitable at some stage – that’s not the problem. The problem is when these unhelpful behavioural patterns start to set in.”Among them is the ‘pursuer-distancer’ dynamic, whereby one party in the relationship is constantly pursuing the other for sex, which forces their partner further away. “The more someone pursues, the more the other draws away because they’re reading it as being selfish, even though the pursuer is seeking connection,” says Soo.
To rebuild connection, Khan suggests scheduling date nights—or, more directly, diarising time for sex with your partner—and creating an environment that sparks intimacy. “I will say to couples, ‘At nine o’clock, [put] phones and laptops in the other room and then you don’t know what to do other than to sit with your partner,’” she says. “Instead of hugging people and holding hands, we have phones in our hands, so that’s quite obstructive towards touch.”
Communication, too, is key. “Talk about what shaped your understanding of sex and your own needs for sex and sexuality,” says Soo. “For a lot of women, it’s actually feeling close to the person rather than the drive itself. Long-term relationships are all about teamwork. So why is sex any different?”