How does physical change during menopause affect sexual life?

Declining sex hormones signal the end of our reproductive capacities but not the end of our capacity for sexual enjoyment. Despite old stereotypes that women dry up and become nonsexual after menopause, the reality is often quite different. The physical changes that come with menopause may affect our sexuality. Changes in menstrual bleeding patterns are early signals of the menopause transition. Some women's periods just shorten and fade without any fanfare. Other women experience longer and heavier bleeding periods that sometimes may require medical intervention. Anxieties and shame can accompany such heavy bleeding, especially when a woman worries that she will bleed through her clothes. While some women welcome the freedom from menstruation and from the possibility of pregnancy and are more interested in sex, others mourn the loss of fertility and feel less feminine. Sometimes, sex can relieve some of the tension; sometimes, it is the last thing we want. Hot flashes and night sweats can also dim sexual feelings.

For some women, dryness and thinning of the vagina may be the first noticeable and disturbing experience of the menopause transition. These changes can make sexual activities, especially vaginal penetration, uncomfortable or even painful and can test the resilience of their communication with their partners.

Some of us experience changes in our sexual response, including the lack of or greatly reduced sexual interest and desire, problems with mental or physical arousal, less lubrication, and less intense orgasms. These changes may happen gradually or suddenly. We may be confused over whether or not to attribute them to aging, menopause, or the weathering of a long-term relationship.