Sex After Menopause: How to Solve 3 Common Problems and Enjoy It More

There are nearly as many cautionary tales about sex after menopause as there are about losing your virginity. Don't let fear of pain or discomfort stop you from having sex. Understanding what's actually changing in your body can help you avoid or manage any discomfort. Plus, no longer having to worry about pregnancy is a genuine upside of menopause!

Understanding Menopause

Menopause marks the point when your body stops menstruating and can no longer conceive. It's officially considered to have begun twelve months after your final period [1, 2]. The North American Menopause Society puts the average age of onset at 51 [3] — meaning you likely have decades ahead of you to enjoy a satisfying sex life. That said, some women reach menopause earlier due to genetics, certain cancers, or smoking, while others continue menstruating well into their fifties.

The transition happens gradually rather than all at once. Perimenopause comes first, followed by menopause itself, and then postmenopause [4]. Ovarian function begins declining several years before your final period [5]. As estrogen levels fall, symptoms may emerge [3] alongside irregular periods, until they eventually stop altogether during the second stage.

This transition can bring a range of symptoms — hot flashes, night sweats, heart palpitations, and migraines among them [3]. Your body may even start to feel unfamiliar as you move through it. It's a lot to navigate, but there are real solutions available.

Surgical Menopause

While most people picture menopause as a natural process, there's another path: surgical menopause. This occurs following removal of the uterus, known medically as a hysterectomy [6]. The procedure sometimes includes removing the ovaries as well (oophorectomy) [7]. Without ovaries producing estrogen, menopause begins immediately.

Undergoing a hysterectomy at a younger age means experiencing surgical menopause earlier than you otherwise would have. The symptoms mirror those of natural menopause and can similarly affect your body, mental state, relationships, and sex life. However, surgical menopause can begin abruptly [2] and tends to be more severe [8] than the natural version.

A common worry among women is whether their partner will still find them desirable and want intimacy afterward. The answer, both times, is a firm "yes." Single or widowed women sometimes wonder whether a new partner would still want them given their changing bodies. The good news: not only will your partner likely still want you, but some of the changes you're going through might appeal to him even more.

Keep in mind that attraction isn't purely about physical appearance. But if you're hoping for a confidence boost, a piece of sexy lingerie can help. Learn how to choose the right lingerie for your body.

Sexual Desire After Menopause

Plenty of women wonder if their desire for sex will hold steady after menopause. And why wouldn't it — life is far from over! Desire typically doesn't decline until the later stages of menopause [9], though many women who go through surgical menopause do notice a drop [10, 11].

But…

Estrogen peaks during the luteal phase of the menstrual cycle and then drops [12, 13], and desire tends to follow that same downward trend.

Estrogen also dips during menstruation [14, 15] and once the honeymoon phase of a relationship fades.

Research has similarly found that desire can drop noticeably during [16] and after pregnancy [17], as well as during stretches of high stress.

Both men and women see their sex drive decline over the course of life, but women are two to three times more likely to experience this drop than men [18]. That said, some women actually feel their libido increase as kids move out and/or retirement frees up their time. Still, the mood swings and temperature fluctuations that come with menopause certainly don't help set the mood.

We recommend that women in menopause, as well as those who are postmenopausal, look at the guidance we've already put together on this topic. These posts can help with a moderate dip in libido:

• 11 Powerful Techniques Show You How To Get Horny Quickly
• How to Increase Sex Drive by Fixing These 6 Common Issues
• How To Get In The Mood For Sex
• The Surprising Science of Sexual Desire That You Can Use To Your Advantage

One piece of advice we consistently give women struggling to get in the mood, whether alone or with a partner, is to slow down and lean into foreplay. Longer foreplay can help address a challenge we'll cover shortly — adequate lubrication. There's really no downside to more foreplay. It helps put you in the mood, gets you wet, and sometimes even brings you to orgasm before intercourse even begins.

Ready to give it a shot? Take a look at our 22 tips and tricks for incredible foreplay. Because hormonal shifts during menopause add extra complexity, foreplay alone may not resolve every issue you run into.

What Happens as Estrogen Levels Drop

Research consistently shows that women experience challenges with desire, arousal, orgasm, and overall sexual satisfaction after menopause [19].

Even when you're eager for sex after menopause, you might hit some snags. It can feel uncomfortable or difficult because your body no longer lubricates the way it once did when estrogen levels were higher. Lower estrogen means reduced vaginal moisture for many women, and can even lead to vaginal atrophy [20, 21, 22] — also called vulvar and vaginal atrophy, or VVA [23]. As many as 50% of women experience some degree of vaginal atrophy during menopause [24].

Reduced estrogen can also lead to recurring urinary tract infections, thanks to increased bacterial growth in the vagina [5], along with inflammation that can trigger vaginal discharge [25].

Women are often taught that wetness is the primary sign of arousal, but that's not always accurate. It's entirely possible to feel aroused without your body producing much noticeable lubrication [26].

When your mental arousal and physical arousal line up, that's referred to as concordance [27, 28, 29]. Many women, though, experience arousal nonconcordance instead, where the two don't match up [30 ch 6]. That means your body might not generate the moisture you'd need for comfortable sex, particularly during longer sessions.

This mismatch — being mentally turned on without becoming physically wet — is something a lot of postmenopausal women find hard to ignore.

The reality is that simply adding more foreplay might not be enough to solve this on its own anymore.

Given everything at play during menopause, it's no surprise that 53% of women experience some form of sexual dysfunction during this stage [31].

So the real question becomes…

What can you actually do if sex after menopause feels dry and uncomfortable?

Try Kegel Exercises

One study found that menopausal women who practiced Kegel exercises had an easier time becoming aroused compared to those who didn't [32].

Learn more about the benefits of Kegels here.

Reach for Lube

The simplest fix is personal lubricant, available at sex shops, online, and even your local pharmacy. With so many options on the market, what should you actually be looking for?

• A water-based lube is a versatile pick that works with any toy and any type of sex, and it rinses off easily.
• Silicone-based lube offers a slicker, longer-lasting feel that's condom-safe and doubles nicely as a massage oil.
• Natural oils like coconut oil are a good choice if you'd rather limit added ingredients and aren't relying on condoms for STI protection (oil breaks down the latex in condoms). Oils also work well for anal sex.

Personal lube can also introduce sensations like cooling, tingling, or warmth, and flavored versions are great for oral sex. Get the full rundown on lube here.

A vaginal moisturizer is another option worth considering — unlike lube, it absorbs into the skin to add ongoing moisture rather than just slickness during sex [33]. Experts note that using a vaginal moisturizer twice weekly can improve vaginal moisture, elasticity, and acidity levels [34].

Something Else to Keep in Mind

You might not immediately think of it, but declining estrogen can also weaken bones and contribute to osteoporosis, since estrogen plays a key role in bone density [35]. This condition leaves bones brittle and prone to breaking — roughly 50% of women over fifty will experience an osteoporosis-related fracture at some point [36].

Keep this in mind during sex, especially since you might find yourself craving rougher sex after menopause than you did before. Reduced vaginal sensitivity can leave you wanting things "harder" — just be mindful not to overdo it.

Read: Rough Sex: The Intensely Passionate In-Depth Guide for more on what that actually involves.

Psst, we've also got a full guide on senior sex.

Because estrogen decline can contribute to osteoporosis [37], it's worth being cautious during sex to avoid fractures. Steer clear of positions that put sustained pressure on your joints. A pillow can relieve pressure points, and specialized sex pillows make awkward positions much more manageable.

On top of that, positions where you're on top tend to be gentler on your body and hips, making them some of the best choices after menopause.

If riding your partner isn't something you've done much of, it's normal to feel a little unsure. Fortunately, we've written a full guide to help you feel more confident on top. Read it here. Then browse our favorite girl-on-top positions.

You can also shift focus toward activities beyond intercourse. Making out, dry humping, and oral sex are every bit as satisfying as penetration, not lesser stand-ins for it. These fall under what's known as outercourse.

Related: All About Outercourse

Talk to Your Doctor About Hormone Therapy

Hormone therapy — sometimes called hormone replacement therapy, or HRT — is another treatment option for menopause symptoms. Your doctor may prescribe estrogen supplements to address many of the issues caused by the steep drop in estrogen during menopause or even premenopause. Creams, pills, patches, and sprays are all options for replenishing lost estrogen [39, 40].

NAMS recommends low-dose local estrogen (rather than full HRT), delivered as a cream or suppository placed directly in the vagina, if your main concern is vaginal dryness or discomfort during sex [41, 42, 43]. An estrogen-containing tablet, cream, or vaginal ring can also help with bladder issues in addition to vaginal symptoms tied to menopause [44].

That said, you might still want to use lube on top of hormone therapy. At the Love Curi, we recommend lube for everyone, regardless of age!

HRT isn't risk-free. Hormone therapy is linked to an increased risk of heart disease [41].

There's also research suggesting that "the effectiveness of ERT may diminish in some women after long-term use [45]."

Whether or not estrogen therapy helps, you may find yourself needing to get reacquainted with your body — its responses, its sensitivities, and your own desires. Some women feel less feminine or less like themselves during and after menopause. Your partner may need some guidance navigating these changes with you, which is exactly why talking about sex matters so much.

Some women are also good candidates for testosterone therapy, particularly if they've noticed a drop in desire that estrogen alone doesn't fix [46]. Testosterone supplements come in forms similar to estrogen options.

If you've been with your partner a while, you're probably already fairly comfortable talking about sex. It's a skill worth sharpening, precisely because it matters so much.

Read: Use Sexual Communication for Complete Sexual Fulfillment

Sex After Menopause Still Carries Some Risk

One clear upside of sex after menopause is no longer worrying about pregnancy. But there's still a risk of contracting an STI through unprotected sex. STIs like HPV are so widespread that most people will contract it at some point in their lives [47], so vigilance still matters.

In fact, STI rates are climbing across most age groups, including older adults [48, 49], possibly tied to the fact that this age group is the least likely to use condoms [50], perhaps because condoms get mentally filed under "pregnancy prevention" rather than STI protection.

Get tested for STIs whenever you have a new partner, and use condoms with anyone who has an STI or an unknown status. Keep in mind that some STIs spread through skin-to-skin contact [51], so condoms won't guard against everything — but they're still worth using for the protection they do offer.

Plenty of women need time to adjust to sex after menopause. But many also find it's the best sex of their lives, free from pregnancy worries and finally able to explore their sexuality more openly than ever before.

July 30, 2020