Changes in hormones (estrogen) sets forth an interplay of factors, including thinning of vaginal skin, reduction in blood flow, and a loss of tissue elasticity. As a result, the vagina can become dry, itchy, and irritated. These can create pain during sex in addition to other possible changes that can occur with muscle atrophy.
In fact, it is estimated that 30% of women in North America stop having sex due to menopausal pain, and by the age of 50, only 51% of women are sexually active, declining to 27% in our 70’s. There is also a possibility that orgasm strength and duration can decline, or it can take a longer time to achieve orgasm.
While it is not fully understood, one hypothesis is that the estrogen decline reduces blood flow to the area, causes clitoris tissue changes, and can weaken the pelvic floor, all contributing to a change in orgasm. All of this is happening at a time when women have mastery over their careers, the nest is emptying out, leisure time is presenting itself, and women should be having the best sex of their lives.
So, why are we accepting this?