Your Top Menopause Sex Problems, Solved

Dryness, pain and other changes you’re likely to experience with the “Big M.”

Medically reviewed in January 2020

If you’re like most of us, discussing problems with your sex life can be uncomfortable. But when it comes to sex after menopause, there's plenty to talk about. As if hot flashes and night sweats weren't enough to cope with, some physical issues associated with the transition may make sex painful or even difficult.

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

Thankfully, there are many treatment options—both medical and natural—to help you get back to enjoying the pleasure again.

We asked Lauren Juyia, DO, an OBGYN with Oak Hill Hospital in Brooksville, Florida, to discuss the top complaints she hears about sex after menopause, plus how to remedy the issues.

Complaint #1: “It’s really dry down there.”
The most common complaint of post-menopausal women? “Everything feels very dry, like sandpaper," says Dr. Juyia. 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, says Juyia. If that doesn’t work, see your doctor, who may prescribe an estrogen cream to apply directly to the vagina. These creams can help restore some moisture to the area.

Complaint #2: “Sex is painful.”
Vaginal dryness can make intercourse difficult—and who wants to have sex when it hurts?

“In postmenopausal women, the most common cause of painful sex is a lack of estrogen,” Juyia says. "I tell my patients that the vaginal tissue gets wimpy without the estrogen around." 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. Spend a few minutes kissing or cuddling with your partner before you move on to the main event. Doing so can help the area become moist, which will increase the pleasure.

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

“Some patients say that sex is different now because their husbands are older and have medical problems that makes traditional intercourse difficult,” Juyia reports. If your partner is having problems maintaining an erection, if he reaches orgasm too quickly (or too slowly) or is no longer interested in sex, urge him to see his doctor, too. Smoking, certain medications like antidepressants and low testosterone levels, among other things, may be to blame. Luckily, there are treatment options that can help.

Finally, some couples 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 can help, and if you're lucky enough to have a sex therapist in your area, consider making an appointment.

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 have.

Complaint #3 “I’m just not interested in sex anymore.”
You guessed it: 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 feeling “in the mood.”

The general emotional changes women experience during menopause can also lead to a decreased interest in sex. The stress, depression, anxiety or sleep problems that may came along with the change can all contribute.

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 below their normal position), treatment options include:

  • use of a pessary, a device inserted into the vagina that helps support the pelvic organs
  • Kegel exercises
  • weight loss
  • surgery, in some cases

If everything checks out medically, your doctor may suggest counseling to help sort out any underlying emotional issues.

"The brain is the woman’s most important sex organ,” Juyia says. Seeing a sex therapist is best, but "any counselor willing to do individual and couples counseling can be helpful."

Although some women will experience low sexual desire after menopause, many women will experience the exact opposite. Some may enjoy sex more than ever before, since there is no longer any pressure or fear of becoming pregnant. What’s more, many postmenopausal women have fewer responsibilities when it comes to children, work and household duties, so there may be more time for relaxation and sex.

This journey is your own 
If you’re just not into sex these days, that’s okay. When it comes to sex, "what seems normal to one woman could be too much or too little to another woman," says Juyia. "All that matters is how you feel about it."

If a loss of interest in sex doesn’t bother you or your partner, don't worry about trying to fix it. If, on the other hand, it is concerning you or affecting your relationship, there are steps you can take to light the spark again.

If maintaining a sex life is a priority, it’s worth trying to address the potential stumbling blocks once you feel comfortable doing so. Some of those issues, 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.

When it comes down to it, every couple’s sex life different, and there’s no “normal” when it comes to frequency. You and your partner should have sex whenever it feels right to both of you. If you’re having difficulties, talk to your doctor so you can get back to enjoying sex again.

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