When menopause arrives, everything changes, including your sex life. Instead of hot nights of passion, you get stuck with night sweats and hot flashes. You may think your days of intimacy are over. However, menopause and sex can coexist.
“It’s important that you feel empowered to raise the topic of sexual health in a way that’s comfortable for you,” says Dr. Sharon J. Parish, professor of medicine in clinical psychiatry at Weill Cornell Medicine. “The first step is to know what you want and not be afraid to ask for help.”
Look below to find out how to nurture sexual desire and overcome common sexual side effects of menopause.
What Are the Phases of Sexual Function?
When you think of sex, you likely think of intercourse. However, sexual health is bigger than that. Dr. Parish states that there are a few key domains of sexual response:
- Desire. This is the root of sexual activity. You may suddenly develop a passion, or it may build over time through anticipation.
- Arousal. Also known as being turned on, this takes place in your brain (mental arousal). It also affects your body (genital arousal). Your genitals swell and tingle with arousal, and you produce vaginal lubrication.
- Orgasm. The goal of many sexual encounters is to achieve an orgasm, an intense, pleasurable tension release.
- Resolution. The body returns to its normal state. Your breathing and heart rate decrease, and your muscles relax.
Menopause can affect all of these domains.
How Does Menopause Affect Sex?
There are a few things that can affect your sexual function.
Hormone Changes
Hormone levels shift during menopause. Most notably, your ovaries quit producing estrogen. This can cause vaginal dryness.
“The biggest complaint or concern I hear is vaginal dryness and pain with intercourse or sexual activity,” Dr. Parish says. “If you’re not lubricated, an orgasm may not occur because you’re uncomfortable.”
Medications
Antidepressants are one of the most common medications that reduce sex drive, but there are others. Cardiovascular medications can reduce blood flow to the genitals, making it harder to experience sensations in the area. Additionally, antihistamines can dry out vaginal tissue.
Other Menopausal Symptoms
Along with vaginal dryness, other common menopausal symptoms include night sweats, hot flashes and difficulty sleeping, according to the National Institutes of Health. Any of these can make you less interested in sex.
Psychological or Relationship Issues
Going through menopause can affect your body image. You may feel less attractive and lose interest in sexual activity, especially if vaginal dryness results in painful intercourse. Additionally, relational strain with your partner can make it more difficult to engage sexually.
Overcoming Physical Discomfort and Arousal Issues
If you’re experiencing painful intercourse or difficulty getting aroused, Dr. Parish has a message for you.
“We need to give women permission not to have painful sex until the problem is solved,” she says, “because all it does is reinforce negative feelings about one's sexuality, one's partner and what sex is.”
There are many ways to address sex issues caused by physical problems during menopause. They fall under two categories: non-hormonal and hormonal menopause treatment.
Non-Hormonal Solutions
To make sex more comfortable, non-hormonal care may help. These over-the-counter options can be purchased at your local pharmacy without a prescription.
- Lubricants. Water-based vaginal lubricant can overcome in-the-moment vaginal dryness. Apply lubricant immediately before or during sexual activity.
- Moisturizers. Vaginal moisturizer is a maintenance cream for vaginal tissue. Use it every few days to keep your vagina moisturized and make sex less painful.
- Vaginal dilators. “As you go through menopause and beyond, vaginal tissue can lose its elasticity,” Dr. Parish says. “A vaginal dilator can help stretch the tissue.” This approach may help if you haven’t had sex in a long time and other methods don’t make sex more comfortable.
Additionally, pelvic floor exercises, such as Kegels, can help you feel aroused and reach orgasm more easily. To perform Kegels, imagine you’re tightening your vagina around a tampon. Hold this position for three to five seconds, relax and repeat 10 times.
Hormonal Solutions
When intimacy difficulty persists despite over-the-counter treatment, prescription hormone therapy may help. Your women’s health provider may recommend a variety of options, including:
- Systemic estrogen. Increased estrogen levels can help reduce vaginal dryness. By going throughout your body, it can also improve other symptoms, such as night sweats and hot flashes.
- Testosterone. Taking this may increase your sex drive. However, it can come with unwanted side effects, such as facial hair growth or acne. Though effective and frequently prescribed for menopause symptoms, the American College of Obstetricians and Gynecologists reports that testosterone has not been approved yet by the U.S. Food and Drug Administration (FDA) for this purpose.
- Vaginal estrogen. This treatment provides a lower dose of estrogen than systemic estrogen prescriptions and is applied directly to the vagina. Dr. Parish states that it is a highly safe and effective way to improve tissue quality, moisture and blood flow in and around the genitals.
When Sex Issues Aren’t Physical
At any age, what’s going on inside your head affects your sex life. Fortunately, there are ways to get your head back where it needs to be for sex during menopause.
- Be present. The busyness of life can leave little mental energy for intimacy. Practice mindfulness, and you may feel a renewed interest in sex. Put your work, shopping list and other needs to the side. Then focus on your partner to move toward desire and arousal.
- Communicate with your partner. Take ownership of your sexuality. Talk about your sexual desires and expectations, what gives you pleasure and what causes pain. Work with your partner to be on the same page.
- Give yourself time. As your body ages, it can take longer to get turned on, according to the Office on Women’s Health. That’s okay. Engage in additional foreplay and be patient.
- Put sex on the calendar. Instead of hoping you get in the mood spontaneously, Dr. Parish recommends scheduling time for sexual intimacy. Doing this can help you get in the mindset needed for a sexual encounter.
- Redefine sexuality. Sex does not have to be standard intercourse. There are other ways to be intimate with your partner. Research and explore these together.
- Seek help. Talk with your health-care provider, mental health counselor or sex therapist about issues involving your sex life. You can also have your partner join you. “Thanks to Digital Health Services, this is easier than ever,” Dr. Parish says. “Your partner may not feel comfortable coming to an office, but they might be willing to sit in front of a camera.”
In Conclusion
You can maintain a fulfilling sex life during menopause. To get started, focus on the physical and psychological sources of frustration.
- Hormone shifts, medication side effects and other complications of menopause can make it more difficult to get in the mood for sex and reach orgasm.
- Intercourse can be more pleasurable with over-the-counter lubricant, prescription hormone replacement and other treatment options.
- To overcome non-physical obstacles, practice mindfulness, schedule time for sexual encounters, maintain open communication with your partner and be open to professional help.
Weill Cornell Medicine experts are here to help improve your sex life before, during and after menopause. Find a doctor today.
