7 Ways to Keep Your Sex Life Alive After Menopause

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 hope).

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.

“All of these symptoms are common, though not every person will experience all of them,” says Emalee Danforth, CNM, MSN, a certified nurse-midwife at the Center for Reproductive Health and Fertility at UW Medical Center – Roosevelt and a UW teaching associate of Obstetrics and Gynecology.

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, especially since estrogen deficiency can change things in your genital area.

And those changes can even happen to people 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 the vagina (the walls aren’t as stretchy)
• Less blood flow to the genital area (less feeling)
• A smaller clitoris
• A smaller labia

All of these symptoms can cause sex to feel uncomfortable or even painful. Some women might even experience a condition known as vaginal atrophy.

“The symptoms of vaginal atrophy can range from mildly annoying to debilitating,” says Danforth. “Less estrogen means less vaginal lubrication and less elasticity in the vagina, which can make intercourse uncomfortable and even painful.”

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 can already be a complex thing that is affected by many factors.

Menopause experts often say that the biggest sex organ is your brain — the mind and body are closely intertwined when it comes to libido.

For example, if every time you try to have sex it’s painful and not a pleasurable experience, then your brain is going to start telling your body that you’re not interested in sex — which will obviously affect your sex drive.

Plus, during the years that menopause hits, women have a lot of competing things going on in their lives (and their heads). They may be reaching the peak of their career at work and dealing with children or parents who need care.

These factors, in addition to things like lack of sleep because of hot flashes and night sweats, body image issues and even certain medications, can all impact both spontaneous desire and even receptive or responsive desire (when you get intimate and then desire develops).

Don't fret — there’s still hope

Fortunately, our expert has plenty of advice and tips for moving forward with your sex life during and after menopause and making things all around more enjoyable.

Here are some things Danforth suggests:

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 Danforth.

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 (or may not) lead to sexual activity but will build intimacy.

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 non-scented 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 yourself just with water, but if you want to use something, use 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 local estrogen therapy. Though it can be given several ways, the most common is for patients to use a vaginal 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.

Systemic estrogen therapy (usually given as pills or patches) is a different approach and can help with other symptoms including hot flashes and night sweats.

“There are different risks to local vs. systemic estrogen therapy,” says Danforth. “If an individual's main concern is vaginal health, local therapy is the best choice. If they have whole body low estrogen symptoms, then systemic estrogen is the best choice.”

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 help you learn exercises like Kegels, which strengthen the pelvic floor and 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.

Danforth says that there is some data supporting supplemental testosterone’s effects on libido, but that sometimes acne and facial hair growth might happen, and long-term risks are still being looked into. Want to be on the safe side when it comes to testosterone? Check in with your doctor or with a board-certified menopause specialist first.

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.

“Although many people find it hard to discuss their sexual problems, your healthcare team is a good resource to help you get back to your optimal sexual health,” says Danforth. “Plus, counseling can also help you cope with the difficult medical or personal issues that might be contributing to your sexual health concerns.”