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Sex after menopause is important for many women even though the experience often changes significantly. Half of women in their 50s report continued sexual activity, but this percentage declines to 27% in women in their 70s. When the physical and emotional symptoms of menopause emerge, many women find themselves navigating unfamiliar territory in their intimate relationships.
Three of the most common concerns related to sex during menopause are vaginal dryness, pain during intercourse, and a lack of desire. Furthermore, more than a third of women in perimenopause or menopause report having sexual difficulties, from decreased interest to trouble achieving orgasm. These challenges often stem from hormonal changes like dropping estrogen levels reduce blood flow to the vagina, making it less sensitive to touch, less elastic and less receptive to physical arousal. Consequently, painful intercourse affects about half of post-menopausal women and is one of the most common reasons women shy away from sex.
Despite these challenges, satisfying sex after menopause is possible. Although menopause transforms the body and changes sexual experience, there are ways to help women reclaim their intimate lives during this significant life transition.
Menopause primarily affects sexual function through the decline of key hormones. As estrogen levels decrease, the vaginal lining becomes thinner, less elastic, and produces fewer natural lubricants. Additionally, lower estrogen causes reduced blood flow to the genitals, making arousal more difficult and delaying vaginal secretions.
These physical changes can lead to genitourinary syndrome of menopause (GSM), and GSM affects at least half of women entering menopause. GSM is characterized by vaginal dryness, itching, burning, pain during intercourse, and sometimes urinary urgency, frequency, or infections - all caused by decreased estrogen levels after menopause or during perimenopause. Furthermore, the vaginal canal may narrow and shorten, while the labia minora often thins and flattens and the clitoris may become less sensitive to touch and stimulation. The urinary system is also affected because tissues lining the urethra contain estrogen receptors and lower estrogen levels impair the normal functioning of those tissues. This creates a perfect storm for infection in the bladder and urethra. GSM is widely under-diagnosed and under-treated due to lack of awareness, stigma and a reluctance to speak openly to doctors about the challenges women are facing.
As mentioned above, sexual response mechanisms may also change. Many women experience altered nerve function, which can delay clitoral reaction time and result in slow or absent orgasmic response. Additionally, the previously accordion-like vaginal “rugal folds” in the vagina flatten. Rugal folds are the ridges or wrinkles on the vaginal walls that allow the vagina to expand for sexual intercourse and childbirth. Flattening of the rugal folds prevents the vagina from expanding properly during arousal and intercourse and makes achieving comfortable and enjoyable sex very difficult.
Having said all that, it’s interesting to know that sexual experiences after menopause vary widely among women. Some report improved sexual desire after menopause due to freedom from pregnancy concerns and fewer child-rearing responsibilities. Others find that night sweats and sleep disruption from hot flashes leave them too tired for intimacy.
Many women discover that effective solutions for sexual challenges exist beyond simply accepting discomfort.
As a first move, many women turn to vaginal moisturizers provide ongoing relief from dryness when used regularly, ideally 2-3 times weekly. These differ from lubricants, which only offer immediate relief during sex. Moisturizers are designed to restore moisture all the time, not just during sex. They provide a protective barrier that helps hydrate the vulnerable lining of the vagina. They can also improve tissue health and increase the elasticity, pliability, and integrity of vaginal tissue. Also, some moisturizers are formulated to help restore the vaginal pH to its normal, healthy range (3.5–4.5). A balanced pH can prevent infections like bacterial vaginosis. And, regular use of moisturizers can relieve some symptoms such as itching, burning, and irritation. Make sure that you ask your physician or health care provider for a brand recommendation. You will want to stay clear of fragrances and other additives. A doctor’s recommendation that is specifically appropriate for this purpose is key to getting the best product and having the best results.
Other prescription options include local, cream-based estrogen therapy. This is applied directly inside the vagina and effectively rebuilds vaginal tissue without significant systemic absorption. Discuss this with your physician to see what prescription options are viable. Don’t be shy about having open discussions with your physician; they already understand this situation and they are there to assist you.
Pelvic floor exercises play a crucial role as well. Regular Kegel exercises strengthen pelvic muscles and can improve urinary incontinence symptoms that affect many postmenopausal women. These exercises subsequently enhance sexual function by increasing blood flow to the vagina.
Also open communication with partners about changing needs is an essential yet often overlooked solution. Discussing preferences and exploring new positions or techniques can significantly improve satisfaction. Arousal may take more time and your partner needs to know this. Good sex at this time of life requires that the partner have an understanding of the changes a woman’s body has gone through.
Regular sexual activity itself provides benefits, releasing endorphins and oxytocin while maintaining vaginal health. This creates a positive cycle where intimacy becomes increasingly comfortable with continued practice.
The journey through menopause undoubtedly presents obstacles for many women's intimate lives. However, armed with knowledge, appropriate solutions, and honest communication, women can adapt to these changes. Sex after menopause might be different, but with the right approach, it can be equally – or even more – satisfying than before.
