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There’s no doubt that along with “the Change” (yes, that big menopausal one) come many changes to your body, and some of them are ... not exactly welcome. One of the more notable ones? Your relationship with sex. And no, your nether regions don’t just shrivel up and die, leaving all traces of lust and desire in the dust — but things are different.
The good news? You can face those new and different circumstances head-on if you’re armed with information (and even hope) from our trusted experts from UW Medicine and Fred Hutchinson Cancer Center.
What is menopause?
Menopause is, clinically speaking, when a woman, or person assigned female at birth, goes 12 months with no menstrual bleeding. The average age for this to happen in the United States is 51. It is important to note that menopause isn’t something that just happens in one day — it’s more of a loose time period during which your estrogen waxes and wanes and ultimately declines. During this time, common symptoms include hot flashes, difficulty sleeping, weight gain, night sweats, mood changes and more.
“Some people won’t have any symptoms at all, and some people will continue to have symptoms for years to decades after they stop bleeding,” says Dr. Sarah Villarreal, an assistant professor of obstetrics & gynecology at the UW School of Medicine who practices at Harborview Medical Center and UW Medical Center. “Everyone is a little bit different.”
Physical symptoms ... down there
Despite what the average teenager might think, 51 is actually not that old — there’s plenty of life left that could include plenty of sex, if that’s something you’re interested in. But sex might look a little different after experiencing menopause.
“Estrogen deficiency can change things in the genital area,” says Dr. Linda Mihalov, OB-GYN at Fred Hutch and at UW Medical Center — Montlake.
And those changes can even happen to those who have otherwise not experienced many noticeable menopausal symptoms. Women who haven’t been dealing with excessive hot flashes or night sweats might not even realize something strange is going on with their vagina until they try to have sex and realize that ... something is off. Some experiences include:
- A drier vagina
- Less elasticity in their vagina (the walls aren’t as stretchy)
- Less blood flow to their genital area (less feeling)
- A smaller clitoris
- A smaller labium
All of these symptoms can cause sex to feel uncomfortable or even painful. Some women might even experience a condition known as vaginal atrophy.
“With vaginal atrophy, the drop in estrogen will cause decreased blood flow to the vaginal and the vulva tissues, and that can lead to pain with intercourse and difficulty with lubrication during sex,” says Villarreal.
Orgasms can also be affected, since the many nerve endings existing in the genital area can be impacted by the decrease in estrogen.
Menopause + sexual desire
“Sexual desire for women is already a very complex thing,” says Mihalov. “Menopause itself does not necessarily have a direct relationship to desire.”
Menopause experts often say that the biggest sex organ is your brain — the mind and body are closely intertwined when it comes to libido, notes Villarreal.
“Our brains are also very vulnerable to sexual interest and desire being squashed by pain,” says Mihalov. “So, if during menopause you have pain or discomfort every time you try to have intercourse, then your brain is telling your body that you’re not interested — which is very powerful negative feedback and can affect your sex drive.”
Plus, during the years that menopause hits, women have a lot of competing things going in their lives (and their heads). They may be reaching the peak of their career at work, dealing with children or parents who need care.
“All of these things can have an impact on spontaneous desire, and sometimes have an impact on receptive or responsive desire, which is what happens when you get intimate and then desire develops,” explains Mihalov.
Don't fret — there’s still hope
Fortunately, our experts have plenty of advice and tips for moving forward with your sex life during and after menopause.
“When we talk about treatment and therapy, we try to make the goal painless sex that is enjoyable, or having orgasms that are not painful,” says Villarreal. “So maybe you’ll still have to work a little bit to initiate intimacy with your partner, but then these therapies can help make that intimate time more enjoyable.”
Here are some things they suggest:
Tip #1: Talk to your doctor
Whether it’s just plain embarrassment or hesitation to bring up something that seems like a secondary issue, you may not love talking about sex with your doctor. But it’s the most important step if you want to get treatment, says Villarreal.
Tip #2: Communicate with your partner
If you’re partnered up, be open with them about what’s going on with your sex drive and your vagina. Communication is key when it comes to intimacy, and talking about your desires is healthy. Maybe you can brainstorm ways to make sex more comfortable together, or just schedule personal time together that may lead to sexual activity, or it may not.
Tip #3: Focus on foreplay to get in the mood for sex
Jumping into sex cold turkey isn’t always fun, especially when you’re dealing with menopause symptoms. It may be useful to focus on foreplay and arousal to get yourself in the mood. This could be anything from reading a sexy story beforehand to taking a warm bath or getting a massage.
Tip #4: Take care of your vagina
Always treat your vagina kindly but be especially kind during this transition. To keep it healthy:
- Use water- or silicone-based lubricant if you're experiencing some dryness or discomfort. Silicone-based lubricants are especially effective and tend to be more slippery and long-lasting than others.
- You can also use a moisturizer on your vagina — just like you would moisturize your face. Coconut oil is especially good for this, and you can put it on the labia and inside the vagina.
- Don’t use soap on the vaginal tissues. You should be able to clean the vagina just with water, but if you want to use something, Mihalov recommends a gentle cleanser and not a harsh bar soap.
Tip #5: Use vaginal estrogen
If you have pain with sex and experience vaginal dryness, one of the best treatments is vaginal estrogen. Though it can be given several ways, the most common is for patients to use a cream at night. The cream increases blood flow to the area and helps reverse the vaginal atrophy caused by the loss of ovarian estrogen. It also rejuvenates the vaginal tissues, which become thicker, more pliable and better able to lubricate. Plus, it’s a low-risk medication.
“The vagina is one of the few organs in the body that can age backward in response to treatment,” says Mihalov.
Tip #6: Make an appointment with a sex therapist
If you need a little extra support sorting things out, seeing a sex therapist can be really helpful, especially when it comes to difficulty with libido or other issues surrounding your enjoyment of sex.
Tip #7: Find a pelvic floor therapist
Menopause can contribute to the weakening of the pelvic floor muscles, which can cause weird sensations in the genital area when you’re being physically active or having sex, urinary leakage (yikes) and even pelvic organ prolapse — when organs like the bladder or uterus slip into the vagina (yikes, again). Though scary sounding, these symptoms are common in women after menopause, and a pelvic floor therapist can how exercises like Kegels, which strengthen the pelvic floor, can be useful as a maintenance therapy.
What’s the deal with hormones?
Lots of people think that sexual desire is affected during menopause because it is correlated with testosterone levels or estrogen levels, which is why some look into testosterone supplements.
Villarreal says that there is some data supporting testosterone’s effects on the libido, but it is by no means a “quick fix.” To get more information about how useful testosterone supplements might be for your situation, it’s best to check in with your doctor or with a board-certified menopause specialist.
Is it possible to have a sex drive after menopause?
What it all comes down to is, yes, having an active and enjoyable sex life after menopause is within your reach — if that’s something you want, and if you’re willing to reach out for treatment and help if necessary.
“Despite any negative effects that menopause might have on the vagina, some older women find a new sexual freedom with age,” says Mihalov, “Many have outgrown family responsibilities and don’t have quite as much chaos going on in their lives.”
Villarreal agrees, noting that it also helps that people are just talking about sex more openly now. “I think people are adjusting to a new way of being,” says Villarreal. “Also, as a society, I'm hoping we’re doing a little better job of making people feel okay talking about sexual desire and libido and sexual dysfunction with doctors — so they’re learning more about treatments that are available to them.”
