12 Ways Sex Is Different After Menopause
It's 2022. Menopause does not automatically mean the end of good sex.
How does sex change after menopause?
They don’t call it “the change” for nothing, but change is not all bad—especially when you consider that the emotional maturity you’ve gained over time can parlay into happier, healthier relationships. And yes, that can absolutely include sex.
Results from a 2010 survey published in the Journal of Sexual Medicine suggested only 36 percent of women in their fifties have sex at least a few times per month, as do only 29 percent of women in their sixties. However, we think a lot has evolved in the past decade-plus…and if you know the challenges to be aware of, you can manage them with some wisdom so that physical and emotional intimacy continue to nourish this stage of your life.
With that point in mind, here’s a list of key changes women’s health specialists say you may want to keep an eye out for when it comes to sex after menopause.
Your vagina changes
A 2012 review of medical studies that was published in the journal Obstetrics & Gynecology suggested that some 68 to 86.5 percent of women have problems with sex in middle age. However, there are treatments that work. “These are extremely common problems, and unfortunately they’re not often addressed by the patients or by the physicians, so we have a lot of very unhappy ladies out there,” says Mary Jane Minkin, MD, director of the Sexuality, Intimacy, and Menopause clinic at Yale New Haven Hospital.
One major root of the problem with sex post-menopause? A lack of estrogen. “The vaginal walls do become thin, they do become dry, and they do lose a lot of their elasticity” from this reduction in estrogen, says Lauren Streicher, MD, author of Sex Rx: Hormones, Health, and Your Best Sex Ever, and medical director of the Northwestern Medicine Center for Sexual Health and Menopause in Chicago. “Between 50 to as high as 70 percent of women experience these changes.” You may not notice them unless you’re having sex—or try to have sex for the first time in a while.
You may have to work to make sex pain-free
According to the North American Menopause Society, the vaginal drying many postmenopausal women experience can cause painful friction during sex, and studies show that up to 45 percent of women have painful sex following menopause. Fortunately, remedies for this problem can be as close as the nearest drugstore.
There, consider getting yourself an over-the-counter lubricant to ease the friction—though note, not all lubes are the same. “The better lubricants are silicone-based, which are very slippery and last longer than water-based,” Dr. Streicher explains, with two product recommendations: “Replens Silky Smooth is a really good one, and Wet Platinum is another.” You could try a home remedy like olive oil or coconut oil, but they can increase the risk of infection and weaken condoms, which could be an issue for sexually transmitted infection prevention if you’re with a new partner. Another option is an over-the-counter vaginal moisturizer, which you would used regularly to increase water content in the skin.
If OTC products aren’t enough, talk to your doctor. A prescription
Your libido may dip
“When a patient comes in telling me she has a significantly decreased libido—which is a complaint I hear four, five, six times a day—the first thing I do address is vaginal discomfort,” Dr. Minkin says. To this point, Dr. Streicher adds that sometimes we live with this pain and aren’t even conscious of it: “In a protective mechanism, you can develop vaginismus, in which, because your body is anticipating pain, it shuts down even more,” Dr. Streicher says. “The opening of the vagina snaps shut, the pelvic floor muscles contract and have a very high tone.” Eventually, she says, “You have a lot of pain that gets worse and worse and worse.”
In this case, no wonder the thought of sex isn’t totally enticing. But, say the docs, once your pain is under control, you may feel your sex drive rev up again. If not, Dr. Minkin says treating patients with testosterone (which also decreases during menopause) can help you get your groove back. (Here are some libido-boosting tips.)
You can still climax with no problem
Interestingly, Dr. Streicher says the lack of estrogen that can impact the vagina during menopause doesn’t necessarily affect a woman’s ability to climax. “Orgasm is not estrogen-dependent, so women can have a healthy, strong orgasm without any estrogen in their bodies at all,” Dr. Streicher says. “But having said that, a lot of women do benefit from local vaginal estrogen because it increases blood flow and lubrication, which can in turn help enhance the ability to have an orgasm.”
If you’re in pain during sex, you’re going to have a hard time climaxing, but once that problem is resolved, you may find you’re off to the races.
Use it—or you may lose it
You may have heard the expression “use it or lose it” for memory and brain health, keeping your joints healthy, and more…and when it comes to sex after menopause, there is truth to it. “Having sex will increase your pelvic blood flow, and anything that increases your pelvic blood flow is good for moisture,” Dr. Minkin says. In order to get the vaginal benefits of frequent sex, you need to have actual penetration (a toy inserted can work as well) frequently.
One very important note, from Dr. Streicher: you shouldn’t force it if it doesn’t feel good. “A lot of women who have dryness and pain are like, ‘OK, if I keep doing this then it’s going to get better,’ and in fact it gets worse,” she says. “The whole ‘use it or lose it’ thing is only an option if you’re having pain-free sex—so first fix it; and then use it.”
You may have some body issues—or you may feel more confident
Menopause can trigger new body image issues for some women, which can affect how they feel about sex. “We are in a society that venerates youth,” Dr. Minkin says. “When you’re going through menopause many women will say, ‘Oh, this is the end’—which of course isn’t true!” But for other women, with age comes wisdom and greater confidence. “People aren’t as critical of their body parts, especially if you’re with a long-term partner—there’s a real comfort level,” Dr. Streicher says. Plus, you’re more experienced, and in tune with your body and how it works. “There are a lot of young women who don’t understand their own anatomy,” she says.
In a 2016 study in Maturitas, researchers from the University of Pittsburgh found that a number of women aged 45 to 60 were actually more satisfied with sex at midlife, even if they weren’t doing it as much, largely because they felt more comfortable in their own skin and were more proactive about discussing their sexual needs.
Other medical issues can impact your sex life
Although the hormonal changes that accompany menopause impact many sexual issues later in life, they aren’t the only causes. “When you look at a 50- or 60-year-old, half of these women have some other medical problem—heart disease, cancer, diabetes, multiple sclerosis, depression—so we have all these other medical issues that also impact the ability to have a normal, healthy sexual response,” Dr. Streicher says. Your doctor can help discover any medical conditions that often begin at the same time as menopause that can affect your sex life. Plus, medications for these other issues can contribute to problems in the bedroom. “Some medications can decrease libido,” Dr. Minkin says. (Find out the surprising postmenopausal health risks.)
Try new things
After celebrating double-digit anniversaries, your sex life can get, well, stale. “If you’ve been with somebody for 30 years you may not be terribly excited about this individual,” Dr. Minkin says. “I encourage patients to look with their partner for different sex toys that might spice things up.” For some women, this may also mean discovering other ways of having sex besides regular old intercourse. “It’s like, ‘OK, now we’re going to discover new things—it may be bringing a vibrator or new toy into their relationship, or it may be that there’s a lot more oral sex or other kinds of stimulation,” Dr. Streicher says. “For a lot of women this is a whole new thing that they’ve never experienced, and it’s a very positive thing.”
Postmenopausal women who are divorced or widowed may find that a new partner is enough to get their sex drive back into gear, even if they haven’t hopped into the sack in years.
Need help getting started? Here are tips to rekindle the fire and make sex great again.
You may have more privacy—or less
If you have children you may have worried they’d burst in on you when they were young. By the time menopause rolls around, that worry may be history. “Having more freedom and more privacy really can impact folks,” Dr. Minkin says. That said, once the kids head out, elderly parents may be moving in. “There are other stressors that a typical menopausal woman is dealing with: taking care of her mother, her in-laws, and everybody’s coming back on their doorstep,” she says. “So you have people who are tremendously stressed with no opportunity for privacy!”
If situations like this are going on in your life, a sex therapist (as opposed to a sexual medicine doctor) may be able to sort out the numerous priorities that are competing for your attention.
Staying healthy can help you have better sex
People who are healthier have more sex, which makes sense. And although staying fit isn’t going to solve hormonal or psychological problems, it can help you be in better physical condition for active pursuits like sex. “The studies very clearly show that if you take a healthy 70-year-old, they are more likely to be having sex than a sick 60-year-old,” says Dr. Streicher. “Health does trump age.”
Eating right and getting enough exercise can ward off disease and help your overall quality of life, including your sex life. (Here’s what intimate couples do in and out of the bedroom to keep their sex life steamy.)
You might have more daytime sex
Getting enough sleep (seven to nine hours) is crucial for being in the mood, according to the North American Menopause Society. However, during menopause, sleep can suffer—big-time. “With perimenopause, you’re getting sleep disruptions, hot flashes, or ‘night sweats’ waking you up,” Dr. Minkin says.
If you’re too tired at bedtime for sex, Dr. Streicher suggests switching up the time of day you hop in the sack. “A lot of couples find that they are much more likely to have morning sex or afternoon sex because they are tired at night, or they’re sleepier after they’ve had a big meal or a glass of wine,” she says.
Sex actually can get better
There are benefits to no more periods besides not having to worry about unwanted pregnancy. If reproductive issues like fibroids or endometriosis plagued you during your younger years, you might find that menopause actually helps resolve these conditions and makes sex more pleasurable. “If somebody was having pain with sex because of endometriosis, when she goes through menopause that’s going to get better,” Dr. Minkin says.
Because fibroids and endometriosis feed off estrogen, the reduction in the hormone during menopause can help “cure” these ailments. “For women who suffered during her menstrual life, menopause is a blessing for them because they’re really feeling a lot better about sex,” she says.
Next up, check out the unexpected health benefits of sex at any age. Keep reading:
- Obstetrics & Gynecology: "Sexual Function in Elderly Women: A Review of Current Literature"
- Mary Jane Minkin, MD, director of the Sexuality, Intimacy, and Menopause clinic at Yale New Haven Hospital
- Lauren Streicher, MD, author of Sex Rx: Hormones, Health, and Your Best Sex Ever
- North American Menopause Society: "Pain with Penetration"
- Journal of Sexual Medicine: "Sexual Problems and Activity by the Numbers"
- Maturitas: "A biopsychosocial approach to women’s sexual function and dysfunction at midlife: A narrative review"