What You Should Know About Sex After Menopause

When patients come to see gynecologist Dr. Parveen Vahora for help with issues related to sex after menopause, the first thing they often ask is, “Am I normal?”

By normal, they usually mean: Am I normal for having less interest in sex than I used to?

There’s no right or wrong answer, of course. “No one really talks about what happens to a woman’s sex drive after menopause,” Dr. Vahora says. But understanding the factors that can affect libido in midlife and beyond can help women make sense of the changes they’re going through and find the solution that’s right for them.

Do Women Want Sex After Menopause?

A common narrative around menopause is that once it starts, sex ends. But the real answer is more nuanced. Sex drive generally declines with age for both women and men, according to the North American Menopause Society (NAMS)¹. But that’s not true for everyone. And having sex less often isn’t the same thing as stopping having sex altogether.

Though sex may happen less often as we age, findings from major studies show that roughly three quarters of middle-aged women say that sex is moderately or extremely important to them. ²

Among those who have sex less often, many women cite roadblocks like painful intercourse, menopause-related symptoms such as vaginal dryness, and medications that affect sexual performance.³ In other words, it’s not really the case that women don’t want sex after menopause. Often, satisfying sex has just become more challenging to achieve.

Why is Sex Painful After Menopause?

Dr. Vahora notes that many of her patients experience pain or discomfort during sex, which in turn leads to less interest in sex. The pain tends to stem from declining estrogen levels, which can cause vaginal tissue to become drier, thinner, and less elastic.

“The vagina and vulva are mucus membranes,” she explains. “When it gets dry and the skin becomes irritated from friction, it’s like a rug burn.”

Declining estrogen levels, too, can lower libido during menopause and make women less interested in sex.⁴ At the same time, many women in postmenopause are experiencing other issues that can also affect sex drive – relationship problems, stress, mood changes like depression or anxiety, and discomfort with one’s body from weight gain, Dr. Vahora says.

Can You Get Your Sex Drive Back After Menopause?

Add these issues to sex that’s already painful, and it’s easy to understand why many women start to steer away from sex during and after menopause, even if they wish their sex lives were more satisfying. “They just resign themselves to the idea that this is something they have to live with,” says Dr. Vahora.

That said, it’s possible for women to maintain – or reclaim – a satisfying sex life in midlife and beyond, she notes. But it can take time, as well as some soul-searching. Since low libido is usually caused by a number of factors, all of those factors may need to be addressed before sex starts to feel enjoyable again.⁵ “Using a lubricating suppository for a week may not be enough to make it better,” Dr. Vahora says. “Women also need to understand the emotional issues that could be causing their low sex drive.”

How to Increase Sex Drive After Menopause

Strategies and treatments for enhancing a woman’s libido are highly individualized. “The solution depends on what the problem is, so I like to present options. It’s good to do a combination approach based on what the patient feels comfortable with,” she says.

Vaginal moisturizers, as well as over the counter and prescription treatments can all play a role in reducing vaginal dryness and easing discomfort, which can often be related to vaginal atrophy. If women have not had sex in a long time, they may even need to use vaginal dilators or try pelvic physical therapy. Physical therapy can be done at home or with a certified pelvic floor therapist, advises Dr. Vahora.

Stress, mood, or relationship issues may be able to be addressed through therapy. For women who are already taking antidepressants, switching from an SSRI to a different drug like bupropion can help restore diminished libido.⁶  

Natural Ways to Increase Sex Drive After Menopause

Low sex drive doesn’t have to be treated with hormone therapy. For patients who want to enhance their response to sexual stimulation, Dr. Vahora likes recommending supplements, like Ristela. “It’s accessible to patients and it doesn’t come with any risk factors. I even recommend it for patients who aren’t having a problem and just want to make their sex lives even better,” she says.

It’s important to note, too, that engaging in sexual stimulation more often will help to enhance your body’s response. Having regular sex postmenopause can help stimulate blood flow to the vaginal tissues and helps keep vaginal muscles toned, both of which make sex more satisfying and more comfortable.⁷ The key is also communicating with your partner and giving yourself time to become aroused.

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Sex Can Be Great After Menopause

Sex postmenopause doesn’t have to look exactly the same as it did in your 20s or 30s in order to be satisfying. In fact, one important strategy for staying interested in sex is being creative and making changes as you and your partner need them.

That starts with bringing them on board to help you address the issues that are leading to lower libido. “You need two to tango,” Dr. Vahora says. “Partners should be supportive. They need to understand that there may be physical as well as emotional conditions that could be affecting a woman’s sex drive.”

Finally, keep in mind that quantity doesn’t necessarily equate with quality. There’s no “right” amount of sex that couples should be having. Even if you and your partner aren’t having sex as often as you used to, what counts is that you feel connected and enjoy the intimate moments you do have – no matter what they look like.

Resources

1. North American Menopause Society, Decreased Desire, 2021.
2. National Institutes of Health, National Library of Medicine, Menopause and Sexuality, June 2018.
3. Menopause, Sexual Functioning in 4,418 Postmenopausal Women Participating in UKCTOCS: A Qualitative Text-Free Analysis, October 2019.
4. North American Menopause Society, Decreased Desire, 2021.
5. North American Menopause Society, Decreased Desire, 2021.
6. Harvard Health Publishing, Harvard Medical School, Yes, You Can Have Better Sex in Midlife and in the Years Beyond, February 2017.
7. North American Menopause Society, Frequently Asked Questions, 2021.