Sex After Menopause

Sex after menopause can be just as satisfying as sex before menopause. However, the hormonal and physical changes associated with menopause may require some adjustment.

Reductions in estrogen and testosterone may affect spontaneous arousal and physical sensitivity for some people. These changes may be troubling for some but freeing for others. Fortunately, if you want to have sex after menopause, there are ways to make it work for you.

This article will discuss the causes and effects of menopausal changes on sexual function, as well as ways to address them and when to talk to your doctor.

Hormonal Changes in Menopause

As people with ovaries age, they have fewer and fewer eggs over time. They also have fewer ovarian follicles, which produce hormones that help regulate the menstrual cycle and other reproductive systems. Early on in perimenopause, the body can compensate for the loss of follicles. Over time, however, that becomes less possible.

During the early stages of menopause, there are intense fluctuations in estrogen. These fluctuations cause many of the symptoms associated with menopause, including sleep problems and hot flashes. As menopause proceeds and people move into postmenopause, estrogen levels permanently drop and stabilize at a lower level.

Testosterone levels also drop during and after menopause. However, this decline occurs more slowly than the changes in estrogen. Therefore, changes associated with reduced testosterone levels may not be as noticeable.

Estrogen and Physical Menopausal Changes

The drop in estrogen that occurs after menopause affects the structures of the reproductive tract. People often notice problems with vaginal dryness, Many also experience atrophy of the vagina and vulva. These changes may be accompanied by symptoms such as pain during sex or discomfort with urination.

Vaginal discomfort is treatable. Vaginal moisturizers and lubricants can be helpful, as can vaginal estrogens, for those who are interested.

The same treatments that help with vaginal symptoms may also alleviate some urinary symptoms. However, if you are experiencing bothersome pain, including during sex or urination, it is a good idea to discuss it with a physician.

How Menopause Affects Sex Drive

A number of factors can affect a person's sex drive, or libido. Because of this, not everyone's libido is affected by menopause in the same way.

Although the changes in testosterone associated with aging can affect a person's sex drive, research suggests that a loss of libido isn't actually all that common. One study of 500 women in early and late menopause found that while 12% of the perimenopausal group reported a loss of libido, only 3% of the postmenopausal group reported the same.

What makes some people more susceptible to decreased libido? Testosterone fluctuations are only one factor. Other factors that have been shown to be associated with decreased sex drive during menopause include:

• Vaginal dryness
• Depression
• Having children living at home

Overcoming Vaginal Dryness

Menopausal hormone therapy can help with vaginal dryness. This often involves topical or local estrogen to increase the amount of estrogen in the vaginal tissue, which improves blood flow and lubrication.

The advantage of using local estrogen over estrogen pills is that lower doses can be used for the same effect—which has less risk of causing problems. Forms of local estrogen include rings, creams, and tablets.

Over-the-counter vaginal moisturizers can help with mild cases of vaginal dryness. They are meant to be used two to three days per week. Vaginal lubricants are used in addition to moisturizers, as needed during sex.

However, for severe dryness, hormones are the most effective option. For people who cannot use estrogens—for example, those with estrogen-sensitive cancer or a high risk of blood clots—other medications are available. These include:

• Osphena (ospemifene): This is a selective estrogen receptor modulator approved in 2013 for the treatment of vaginal atrophy. It is given systemically.
• Prasterone (dehydroepiandrosterone): This medication can be used orally or vaginally depending on symptoms that need relief.

Can I Use Coconut Oil as a Lubricant? 

Coconut oil has many uses, both in food and in personal care. One of them is that it's a great moisturizer. Solid at room temperature, it melts into a liquid when applied to the skin and gives skin a soft feel and a pleasant scent. People also use coconut oil on their hair and their tattoos.

But is coconut oil a good sexual lubricant? The answer is a solid "it depends." Coconut oil should not be used as a lubricant if you are using latex condoms or other barriers. As an oil, there is a risk that it will erode the condom and increase the likelihood of breakage.

Despite reports in the popular press about the use of coconut oil for vaginal lubrication, there is remarkably little medical literature on the subject. There is some evidence that coconut oil is frequently used as a sexual lubricant in some parts of the world.

One 2020 study suggests it may help address vaginal dryness. There is some evidence that it is safe for vaginal flora (bacteria and yeast normally found in the vagina).

Easing Vaginal Discomfort

Vaginal discomfort is often caused by the same underlying concerns that lead to vaginal dryness. A lack of estrogen can cause a condition called vulvovaginal atrophy, in which the tissues of the genitals become thinner and more easily damaged.

There are also other conditions, such as uterine prolapse, that are more common after menopause. They may also cause discomfort or a feeling of fullness in the vagina.

Vaginal moisturizers and topical estrogens can be an effective way to address vaginal discomfort. Plant-based estrogen formulations may also be a helpful treatment for some people.

Improving Intimacy 

Intimacy is something that changes substantially over a person's lifetime. When people are younger, it's often easier for them to become aroused. Sexy thoughts may be an all-the-time thing, and connecting with a partner may be a simple joy.

These things may become more difficult as people get older. Although remaining sexually active helps keep the relevant body parts doing their thing, that can seem difficult or impossible as one's body and responses change with age.

In particular, people who are used to their body's lubrication signaling to their brain that they're aroused may need to work on doing things in the reverse order.

A lot of sexual arousal happens in the mind. Improving intimacy can start with thinking sexy thoughts. How do you think sexy thoughts? For some people, it involves fantasizing about a partner. For others, it involves reading romance novels or erotic literature. Still others enjoy watching pornographic videos or romantic films.

The trick is to figure out what works for you. Then you can find ways to turn on your mind and give your body a chance to follow.

For people who find that the mind is willing, but the body is not going to enjoy intercourse, there are plenty of other ways to be intimate and sexual. Dancing, erotic massage, oral sex, and other forms of stimulation can bring the same sense of pleasure and connection—or an even better one.

Once you understand what's going on in your body and mind, communication is essential. If you have a regular partner, you may need to find new ways to explore and enjoy each other. That requires open, clear communication about what is and is not enjoyable.

When to Talk to Your Doctor

As a person goes through menopause, it's natural for their experience of their body to change. However, there are certain signs that you should talk to your doctor. These include:

• Irregular vaginal bleeding
• Bleeding after sex
• Pain during sex or urination
• Any symptoms that make it difficult to function in your life

Even more mild symptoms may be worth talking to a doctor about if they're making it hard to live your life. There may be options to help you sleep better and feel better, which can also help your libido and sex life.

If symptoms persist even after estrogen therapy, it warrants evaluation for another cause such as vulvodynia (chronic pain of the vulva), other causes of bladder pain, or pelvic floor dysfunction.

People who are having trouble coping with the psychological changes of menopause should also consider talking with a therapist. A skilled sex therapist may be particularly helpful if you have difficulty figuring out how to reignite your sex life after menopause.

Medications

Estrogen therapies are the most common medication used to improve the symptoms of menopause, including symptoms that affect sex life. Local estrogens can be quite effective at symptom reduction. They also have fewer side effects than estrogen pills or systemic medication.

However, people who still have a uterus may need to take progesterone in combination with estrogen to reduce the risk of uterine cancer.

Individuals experiencing mood changes associated with menopause may benefit from antidepressants. Some antidepressants may also effectively address some of the other symptoms associated with menopause, such as hot flashes and night sweats.

Phytoestrogens, or plant estrogens, can also be an effective way to address menopausal symptoms in some people.

Specialist-Driven Procedures

If your primary care provider isn't helpful enough at addressing your vaginal or other pelvic symptoms, there are other options. A gynecologist or nurse practitioner who specializes in women's health can be helpful in figuring out what exactly is going on in your body and what is the best option for treatment.

Some people also find that pelvic floor physical therapy can be very helpful if they're experiencing pain during sex or other symptoms, such as urinary incontinence, that may be difficult to treat with medication. Pelvic floor physical therapy helps to retrain the muscles inside the body to function in ways that help symptoms, instead of causing them.

Vaginal dilators can be an effective component of pelvic floor physical therapy for people who avoid intercourse due to pain.

Summary

The physical and psychological changes experienced in menopause can have an effect on your sex life. Vaginal dryness can be treated with topical hormones and tactics such as using lube and taking more time for arousal.

A reduced sex drive can be experienced by some people, but many do not have this challenge. Talk to your doctor about any concerning symptoms or effects on your sex life.

A Word From Verywell

Menopause can be exhausting. It's a time when there are numerous changes in your body, and many of them can range from annoying to actively unpleasant.

However, there are also positive changes associated with menopause. Many see the postmenopausal period as one with new freedoms. Sometimes those freedoms involve sexual exploration.

Sex after menopause may require some changes—more time, more lube—but most people can find ways to have an enjoyable sex life if they want to. Just remember to practice safer sex if you're not in a mutually monogamous relationship.

It's also important to use a condom or other form of birth control if you're having sex that could put you at risk of pregnancy and have not confirmed that you are no longer ovulating.