How to Have Great Sex After Menopause

March 25, 2019

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Menopause and sex don't always go hand in hand. Why's that? After menopause, a woman's ovaries stop making estrogen, the main female sex hormone. This can be a tough adjustment, because estrogen is responsible for so many bodily functions, from bone health to steady moods to lower levels of "bad" cholesterol.

But the hardest change many women deal with has to do with the vagina. Estrogen keeps the vaginal lining elastic and moisturized, and it also helps power your libido. Without estrogen, vaginal tissues atrophy, dryness sets in, and arousal is more difficult. When you do have penetrative sex, it can hurt and even cause tearing inside the vagina.

“I see women who’ve gone years being told that a normal part of aging is to have pain with sex,” says ob-gyn Lisa M. Valle, DO, medical director of Oasis Women's Sexual Function Center in Santa Monica, California. “By the time they come see me, that’s what I hear. The fact is, there’s a lot you can do.”

Not all women experience painful sex after menopause. Without the fear of pregnancy, some women say they're more relaxed during intimacy. And at this point in life, they typically don't have young kids to take up all their time, so there's more opportunity to enjoy the action.

But if sex after menopause is uncomfortable or downright painful, there are options, Here’s what you need to know about menopause and sex—and six ways to get back in the saddle again.

Find a lubricant you love

“Vaginal dryness is totally treatable,” says Mary Jane Minkin, MD, clinical professor of ob-gyn at Yale School of Medicine. One option is an over-the-counter vaginal moisturizer designed to be used regularly, say two to three times a week, rather than just before sex. Take a walk down through your local drugstore, and you'll see many different brands.

Then when you're ready to hit the bedroom, apply a water- or silicone-based lubricant intended to be used in the moment, so you get even more of an assist. If you've never checked out lubricants before, you'll be amazed at all the varieties, including natural, additive-free versions and some that come in single-use packets for a quickie on the go.

Have more sex

Sure it seems counterintuitive. But having more penetrative sex can actually help prevent vaginal tissue from thinning and becoming irritated. That's because arousal causes increased blood flow to your genitals, which keeps vaginal tissues healthy. No partner when the mood strikes? Masturbation works, too.

Try a prescription cream

If you’ve tried over-the-counter options and you’re still dry down there—or your sex drive continues to circle the drain—talk to your doctor about medical treatments that can help. One possibility: low-dose estrogen vaginal creams that contain the anti-aging hormone DHA.

A cream isn't your only option. Tablets and rings that go into the vagina and are absorbed via skin are also available. Also, a once-a-day, hormone-free drug, Osphena, has been approved by the FDA that helps thicken vaginal tissue so pain and tearing are less likely. Osphena isn't for everyone, so if you're considering it, check in with your ob-gyn and find out if you're a candidate to take it.

Ask your doctor about testosterone

Testosterone replacement has long been used as a solution for men with a waning libido—and it can help rev up your own sex drive as well. Still, not all doctors are OK with prescribing synthetic versions of this main male hormone (which women also make in small amounts). Testosterone is by no means a cure-all and can come with side effects like acne and thinning hair. Luckily, “newer remedies to enhance libido are being worked on even as we speak,” Dr. Minkin says.

Talk it out with your partner

Even if it's just the physical changes of menopause that are making sex painful, talking it out with your partner can help alleviate the stress and anxiety surrounding the topic. If you're single or your partner isn't the talky type, your ob-gyn is available to lend an ear. “I always encourage women to have a good, trusted gynecological healthcare provider to speak with,” Dr. Minkin says. “A doctor, nurse midwife, or nurse practitioner can be a valuable source of advice.”

You may also want to talk to a sex therapist, who can help you be more open about what you need and want from your partner as well as reminding you that the changes you're experiencing are perfectly normal.

Let yourself experiment sexually

Let’s state the obvious: None of the most common menopause symptoms, from hot flashes to night sweats to fatigue and occasional incontinence, sets you to up to feel desirable. Before these side effects take a toll on your self esteem, talk to your doctor about ways to manage them.

“Just come in right away,” says Dr. Valle. “As time goes on, some problems can get worse and worse.”

Realize, too, that you may have to work a little harder than usual to get out of your funk and in the mood. That means more foreplay, watching porn (with or without your partner), trying out sex toys—or just learning to relax.

“Don’t think your sex life ends once you go through menopause,” assures Valle. “I know an 80-year-old woman who still has sex with her partner. It’s a different stage of life, but a good sex life is still possible.”