May 15, 2022

How Sex Changes After Menopause

A decline in estrogen can cause intercourse issues, but treatments can help

A person sits at the doctor's office while a healthcare provider writes on a clipboard

When you hear about menopause, what do you think of? Maybe you’re focused on fending off hot flashes. Maybe you’re worried about weight gain. Maybe you’re kind of excited not to have your period anymore.


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What about changes to your sex life? For some women, menopause brings a decline in desire or uncomfortable intercourse. This can leave you and your partner feeling stressed, sad and confused.

But it doesn’t have to be that way. Women’s health specialist Holly Thacker, MD, explains how menopause impacts sex and libido and what you can do to better understand your body’s morphing menopausal needs.

How menopause affects sex

When you go through menopause, your estrogen levels drop.

“The vagina and external genitalia have a very high concentration of estrogen receptors,” Dr. Thacker explains. “When you lose hormones, that tissue tends to shrink up.”

And lower levels of estrogen also cause a decrease in blood flow to your vagina, which can make it less sensitive to touch and less receptive to physical arousal.

All of that can make sex less desirable, more difficult, downright uncomfortable — and even painful. And to top it off, the emotional changes that often accompany menopause can cause you to lose interest in sex.

Tips for sex during menopause

So, what’s a menopausal gal to do? First, know that “grin and bear it” isn’t what the doctor ordered. Three of the most common concerns related to sex during menopause are vaginal dryness, pain and a lack of desire — and there’s help for each of them.

“The good news is that there are both hormonal and nonhormonal treatments,” Dr. Thacker says. “No woman should suffer pain or dryness through sexual activity.”


Address vaginal dryness

Less estrogen can mean less vaginal lubrication. One of the most common symptoms of menopause is vaginal dryness, which can make sex uncomfortable and frustrating.

Dr. Thacker explains some of the options:

  • Lubricants: Over-the-counter vaginal lubricants can supplement natural lubrication during sex. “There are good water-based lubricants, and vitamin E oil and coconut oil may also work for you,” Dr. Thacker suggests. Water-based ointments are best (like K-Y Jelly®, Astroglide® and Pre-Seed®, to name a few), and silicone-based lubricants are OK, too. Just be sure to stay away from mineral oil as a lubricant.
  • Moisturizer: Vaginal moisturizers are like lubricants, but they stay in the vagina longer and cling to vaginal walls. Lubricants like Replens® and Silk-E® can be used a couple of times a week (but not at the time of intercourse).
  • Vaginal estrogen: If lubricants and moisturizers aren’t enough, prescription vaginal estrogen therapy can help. “These local agents not only improve symptoms but help restore the vaginal mucosa to normal,” Dr. Thacker notes. It’s available as a cream, dissolvable tablet or long-term insert.

But topical lubricants and moisturizers are just short-term fixes that only address your symptoms. “Anything that you put on to moisturize or lubricate might temporarily make you feel better, but it doesn’t change vaginal integrity,” Dr. Thacker says.

In other words, hypersensitivity at the entrance to the vagina won’t necessarily improve with lubrication. So, if the dryness doesn’t disappear, see your gynecologist. They can prescribe vaginal estrogen or other options like vaginal suppositories or nonestrogen oral medications.

Seek help for painful sex

When it comes to sex, the last thing you want is unintended pain. But for some women, vaginal dryness doesn’t just cause discomfort during sex, it’s simply painful.

Dry, fragile vaginal tissue can lead to vaginal atrophy, which can result in burning, itching, spotting and pain during intercourse. Some women may even experience friction burns while having sex.

“If you have changes in the vagina, do not wait until things are very painful,” Dr. Thacker cautions. “If you do, even when we treat the thin lining and make it healthy again — which we can do usually within a month — sometimes, the muscles of the vagina go into spasm because they remember the painful sexual activity.”

Painful intercourse can have other causes, too, so if you’re experiencing pain during intercourse, it’s wise to have a checkup. Conditions that can cause this issue include:

  • Endometriosis.
  • Ovarian cysts.
  • A pelvic mass.
  • Scar tissue from surgery.
  • Sexually transmitted infection.
  • Vaginitis.

“If you’re experiencing pain with intercourse, it’s important to have an exam to determine the cause,” Dr. Thacker says.

Work on increasing your receptiveness to sex

First, let’s make one thing clear: Every couple’s sex life is different, and there’s no such thing as “normal.” But if your libido is lagging and it’s causing you unhappiness, that’s not normal — or doesn’t have to be.

What is menopause’s impact on your sex drive, though? Dr. Thacker says hormones aren’t the only factor in your sex life. Emotions play a big role, too. So, if menopause is taking a mental and emotional toll on you, you might find yourself less interested in sex.

“Try increasing your receptivity — your ability or willingness to enjoy sex — instead of your sex drive,” Dr. Thacker suggests. There are lots of tips to improve your sex life as you age, like:

  • Improve communication with your partner.
  • Try sex positions that allow you to control penetration.
  • Schedule date nights.
  • Do Kegel exercises to strengthen your pelvic muscles.
  • Read erotic books.

There’s also a link between menopause and depression, as decreased estrogen levels can cause emotional turbulence — and depression can affect every aspect of your life, including sex drive. If you’re experiencing depression, ask your doctor for help feeling like you again, in the bedroom and beyond.

Don’t give up on sex during menopause

If nothing seems to help and you’re bothered by your sexual (dys)function, talk to your doctor — and try not to feel embarrassed. These are common concerns, and your healthcare providers are there to help.

“An integrated treatment approach can treat both medical and emotional issues associated with menopause,” Dr. Thacker assures. You deserve it!

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