3 Ways Sex After Menopause Gets More Challenging (And How To Fix It)—Plus 3 Ways It Gets Much, Much Better!
Plus discover what intimacy changes you can look forward to in midlife and beyond
It’s no secret that menopause can impact many parts of your life. Suddenly, everything from your mental health to your body temperature (hello, hot flashes!) feels like it’s in flux—even your joints may start to ache. While these symptoms tend to get all the attention, there’s far less discussion around sex after menopause, from what can change to what to look forward to.
We spoke to doctors, sex therapists and a sexologist about the real changes menopause brings. And yes, some feel challenging. But others? They might surprise you with their potential to deepen pleasure, boost confidence and strengthen intimacy. Our expert tips can help you navigate every shift along the way.
First, let’s define menopause
“Menopause marks the natural end of menstrual cycles,” says Kate McLean MD, MPH, FACOG, Chief Medical Officer at women’s health brand Evvy. “It’s confirmed when you haven’t had a period for 12 consecutive months. Most people reach menopause between the ages of 45 and 55. This is when the ovaries slow, eventually stop releasing eggs and estrogen and progesterone levels drop. But menopause isn’t a single moment. It’s a transition that unfolds over years (often called perimenopause and postmenopause) that can affect your body, mood and yes, your sex life.” (Discover what doctors really want women to know about menopause.)
Woman's World Answers
3 ways sex after menopause can be more challenging—and how to fix it
Your sex life naturally evolves over time. Menopause brings its own set of shifts that may feel challenging, but there are steps you can take to improve intimacy and comfort. Here we reveal the common bedroom issues that can pop up for women in midlife, plus how to resolve them so you can have enjoyable sex again.
Vaginal dryness
“Vaginal dryness happens because of changes in estrogen,” says Somi Javaid, MD, board-certified ob-gyn, founder of HerMD and a member of the plusOne Wellness Collective. “As estrogen levels drop, the pH in the vagina rises, which actually makes us more prone to infections. Lower estrogen also means less natural moisture, and it reduces collagen, elastin and blood flow in the vaginal tissue. This causes the tissue to become thinner and more fragile, making it easier to get irritated, infected or experience pain during sex.”
What to do: “Use a vulvar moisturizer for daily comfort and a high-quality vaginal lubricant for intimacy,” says Dr. Javaid. “Localized hormone therapy—like estrogen, creams or suppositories—can directly treat genitourinary syndrome of menopause (GSM)” and reduce the likelihood of painful intercourse.
“I am also a big fan of DHEA suppositories to treat GSM and help with sexual function,” Dr. Javaid adds. “There are also energy-based therapies such as laser, radiofrequency and red-light treatments that can help restore tissue health.”
Lower libido
“Libido, or sexual desire, is shaped by a mix of biological, psychological and social factors—what we call the ‘biopsychosocial’ model,” says Dr. Javaid. “Biologically, hormones like estrogen and testosterone play a role [in your sex drive], and during menopause, declining levels can lower desire. Psychologically, how we feel about sex, our own bodies and our mood matter a lot. Work, home life and our relationships all have an impact. During perimenopause and menopause, it’s common to struggle with anxiety, depression, sleep issues or changes in body image—all of which can affect interest in sex.”
What to do: There are several ways to kick your sex drive back in gear after menopause…
- Therapy: “Counseling can be very helpful, as can addressing relationship or psychological factors,” says Dr. Javaid.
- Testosterone: “Testosterone therapy may be appropriate for many women,” says Dr. Javaid. “There is a global consensus statement supporting the use of testosterone for low libido, and as a provider, I find that fascinating. There are not many areas in women’s sexual health where providers align globally.”
- Non-hormonal medication: “There are two FDA-approved medications for low libido in women—Addyi (flibanserin) and Vyleesi (bremelanotide)—which can be prescribed by your healthcare provider,” says Dr. Javaid. “Both are non-hormonal options that work on neurochemistry.”
- Vibrators: “Sexual wellness devices can play an important role in helping women reconnect with their bodies and rediscover pleasure. The plusOne Menopause Massager, designed specifically with midlife women in mind, supports blood flow, sensitivity and comfort, making it a gentle, empowering tool to complement other approaches to improving libido and overall sexual wellbeing,” says Dr. Javaid, who’s affiliated with the brand.
- Audio erotica: “For individuals who do not want medications or hormones, there are apps like Dipsea, which offer audio erotica to help with libido and arousal issues by providing new ways to engage with desire and fantasy,” says Dr. Javaid.
Difficulty achieving orgasm
“Menopause can make it more difficult to orgasm. This mainly is an effect of decreased estrogen and testosterone levels—two hormones that affect that sexual desire, but also the blood flow to the vaginal area,” says Sofie Roos, licensed sexologist and relationship therapist. “Less blood flow means that the vaginal mucous membranes get drier, and that the sensitivity changes, which makes a woman less likely to reach all the way to climax.”
What to do: “The first thing is to use a good lubrication that makes the sex more comfortable and enjoyable,” says Roos. “You can also experiment with new types of stimulation. Sex toys, especially air pulse vibrators, are often a good way to go, but also oral and finger sex can help one reach orgasm easier during menopause. And last but not least, working with sex becoming something joyful without the pressure of orgasming can actually paradoxically make you more able to reach climax in the long run! Just because the body changes, that doesn’t mean that the satisfying part of sex goes away.”
3 ways sex gets better after menopause
If you’re approaching menopause and feeling worried about these shifts, or already experiencing them firsthand, here’s some good news—not all of them are negative. Here’s what you can look forward to:
No pregnancy worries
“Freedom from pregnancy concerns means no more anxiety about contraception or unplanned pregnancy after decades of managing fertility, allowing for more spontaneous and relaxed intimacy,” says Sarah Oreck, MD, MS, a Columbia University-trained psychiatrist focusing on Women’s Mental Wellness with expertise in reproductive psychiatry and CEO of Mavida Health. “Give yourself time to psychologically embrace this freedom and explore what you enjoy without those constraints.”
Skipping the period stress
“No more period-related issues eliminates timing sex around menstruation, menstrual cramps, heavy bleeding and hormonal mood swings, which for many women is genuinely life-changing,” says Dr. Oreck.
More confidence
“Sex after menopause can create a shift from something that women ‘do’ towards viewing sex as a way of being in their bodies,” says Emma J. Smith, PhD, a therapist, certified sex expert and trauma specialist helping individuals and couples navigate the complexities of intimacy, identity and relationships. “It’s a chance to redefine intimacy on your own terms. For many, menopause is when they finally start asking, What do I want? And that question opens doors. You might feel more confident advocating for what feels good, trying new things or reconnecting with your own body outside of someone else’s expectations.”
The bottom line on sex after menopause
Menopause brings real changes to your intimate life—some challenging, others full of possibility. With the right support and expert guidance, you can navigate these shifts and discover a more confident, connected and pleasurable chapter of your sexuality than you ever imagined.
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