Solutions for Top Menopausal Sex Issues

Learn about dryness, pain, and other changes you may experience.

mature couple in bed

Updated on July 24, 2023.

Discussing concerns about your sex life can be uncomfortable. But when it comes to sex before, during, and after menopause, there's plenty to talk about. Physical issues associated with the transition may make intimacy difficult or even painful.

Why? During menopause, the ovaries stop producing the sex and reproductive hormone estrogen, which causes a number of changes in the body. Some of those changes can lead to a low sex drive and vaginal dryness, among other things.

Thankfully, there are many treatment options to help you increase your pleasure.

Complaint #1: “It’s dry down there.”

The most common complaint among post-menopausal people? “Everything feels very dry, like sandpaper," says Lauren Juyia, DO, an OBGYN with Oak Hill Hospital in Brooksville, Florida. “That's a result of the decline in estrogen levels during menopause, which makes the lining of the vagina thinner, drier, and less elastic. This thinning can also cause the urethra to become irritated, which can increase your risk of urinary tract infections—and can cause you to urinate more often, too.

You may be able to treat vaginal dryness at home with a water-based lubricant or moisturizer says Dr. Juyia. If that doesn’t work, see your healthcare provider (HCP), who may prescribe an estrogen cream to apply directly to the vagina. These creams can help restore some moisture to the area. Vaginal estrogen is also available as a tablet or ring that can be inserted into the vagina. 

Complaint #2: “Sex is painful.”

Vaginal dryness can make intercourse difficult. In postmenopausal people, the most common cause of painful sex is a lack of estrogen, Juyia says. Again, estrogen treatments can help—usually within four to six weeks—by making the vagina more lubricated.

“It’s important to be gentle, use water-based lubricants liberally, and just be patient and wait for full arousal, which could mean increasing foreplay,” Juyia advises. Using hands, mouths, or sex toys can help moisten the area.

Keep in mind that your partner may be having issues in the bedroom as well.

“Some patients say that sex is different now because their partners are older and have medical problems that makes traditional intercourse difficult,” Juyia reports. If your partner is having difficulty staying aroused, reaches orgasm too quickly (or too slowly), or is no longer interested in sex, urge them to see their HCP, too. Among other things, smoking and certain medications—such as antidepressants—may be the cause. Luckily, there are treatment options that can help.

Finally, some people may want to seek counseling. “If sex is painful, you may develop a negative association with it that can take a long time to get over,” Juyia adds. Counseling with a sex therapist in your area—or available via telehealth—can help.

Sex therapists are likely to start the conversation by asking about your sexual history, beliefs about sex, and any sexual concerns you have at the time. You may be asked to do some “homework” which can include trying new things like role playing or sex toys, communicating more clearly with your partner about what feels good, or simply increasing the amount of foreplay you engage in.

Complaint #3: “I’m just not interested in sex anymore.”

Low estrogen levels can also affect your libido. And lower levels of estrogen can cause physical changes—like urinary issues, pelvic organ prolapse, and dryness—which may also prevent you from getting in the mood. Stress, depression, anxiety, and sleep problems linked to menopause may contribute, as well.

If you’re experiencing urinary incontinence, pelvic floor strengthening exercises, weight loss, or vaginal estrogen can help. For pelvic organ prolapse (in which the uterus, vagina, or other pelvic organs start to drop into a lower position), treatment options include the following:

  • Use of a pessary, a device inserted into the vagina that helps support the pelvic organs
  • Pelvic floor physical therapy
  • Increasing your fiber intake, which may relieve bowel problems by easing constipation or straining during bowel movements
  • Surgery, in some cases

Juyia calls the brain our “most important sex organ.” Seeing a sex therapist is best, but "any counselor willing to do individual and couples [counseling] can be helpful."

Although some will experience low sexual desire after menopause, others will experience the opposite. Some may enjoy sex more than ever before since there is no longer any pressure to become or fear of becoming pregnant.

This journey is your own

If you’re just not into sex these days, that’s fine. When it comes to intimacy, different things work for different people. "All that matters is how you feel about it," says Juyia

If maintaining a sex life is a priority, it’s worth trying to address some of the physical changes that occur in menopause once you feel comfortable doing so. Some of those symptoms, such as dryness, may be uncomfortable to work through at first. But regular sexual activity in itself stimulates blood flow in the vaginal area and keeps the vaginal muscles toned, helping maintain elasticity. In other words, having sex may facilitate having more.

Ultimately, everyone’s experience with menopause is different, and there’s no “normal” when it comes to sex frequency. You should have sex whenever it feels right. If you’re having difficulties, talk to your HCP so you can get back to enjoying sex again.

Article sources open article sources

NIH: National Institute on Aging. What Is Menopause? Content reviewed September 30, 2021.
NIH: National Institute on Aging. Sex and Menopause: Treatment for Symptoms. Content reviewed September 30, 2021.
Jin J. Vaginal and Urinary Symptoms of Menopause. JAMA. 2017;317(13):1388. 
Mayo Clinic. Vaginal atrophy. September 17, 2021.
Cleveland Clinic. Estradiol Vaginal Ring (Vaginal Symptoms of Menopause). Accessed July 2023.
U.S. National Library of Medicine. Estrogen and the urogenital microbiome in GSM. Page last updated November 22, 2019.
Garcia de Arriba S, Grüntkemeier L, et al. Vaginal hormone-free moisturising cream is not inferior to an estriol cream for treating symptoms of vulvovaginal atrophy: Prospective, randomised study. PLoS ONE. 2022. 17(5): e0266633. 
Streicher LF. Diagnosis, causes, and treatment of dyspareunia in postmenopausal women. Menopause. 2023 Jun 1;30(6):635-649.
Ferrini MG, Gonzalez-Cadavid NF, et al. Aging related erectile dysfunction-potential mechanism to halt or delay its onset. Transl Androl Urol. 2017;6(1):20-27. 
AlBreiki M, AlMaqbali M, et al. Prevalence of antidepressant-induced sexual dysfunction among psychiatric outpatients attending a tertiary care hospital. Neurosciences (Riyadh). 2020;25(1):55-60.
Americal Psychological Association. Sex therapy for the 21st century: Five emerging directions. February 2019.
International Society for Sexual Medicine. What Happens During Sex Therapy? 
Wallace SL, Miller LD, et al. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019 Dec;31(6):485-493. 
Cappelletti M, Wallen K. Increasing women's sexual desire: The comparative effectiveness of estrogens and androgens. Horm Behav. 2016 Feb;78:178-93.
UptoDate Patient Education. Urinary Incontinence. November 2022.
Office on Women’s Health. Pelvic Organ Prolapse. Page last updated February 22, 2021.
ACOG. The Menopause Years. November 2021.

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