Skip to content

Changes to Sex After Menopause & How to Sustain Intimacy

Table of Contents

You felt prepared for the hot flashes and mood swings that accompany menopause. Low libido, though, may catch you by surprise. This is understandable, as it’s a lesser known and often overlooked symptom of menopause. Sexual problems stemming from menopause symptoms are quite prevalent.

Menopause (12 months without having a menstrual cycle) is a natural phase of life that signals a woman’s reproductive years have come to a close. Ovaries produce less estrogen and progesterone, which can cause symptoms ranging from night sweats to vaginal dryness.

Lower estrogen levels also mean less blood flow to genital regions. This can cause difficulty in becoming aroused, lack of vaginal lubrication, and even physical changes. For example, the vaginal walls can weaken, and vaginal tissue can become more fragile. Sexual function can suffer, which may lead to issues in sexual relationships. 

What is the most common reason for sexual dysfunction in postmenopausal women? Sexual dysfunction in postmenopausal women can have several causes. The most common causes are low sex drive, pain during sex, and vaginal dryness.

First, rest assured you’re not alone — many women undergoing menopause experience painful sex and a lack of desire. Second, there are many treatment options to improve sexual health and activity.

Changes to Desire

How does sexual desire change after menopause? Sex drive can change for a variety of reasons. If sex has become uncomfortable or even painful due to vaginal dryness or vaginal atrophy (when vaginal walls become thin and easily inflamed or irritated), it’s no wonder your eagerness to engage has lessened.

Also, sex drive can be affected by mental health. With hormone levels in flux during perimenopause and menopause, women can be more vulnerable to anxiety and depression, as one review indicates.

The North American Menopause Society states that depression rates can double for women during perimenopause and menopause. When emotions and spirits dwindle, sex can become a low priority.

Body image can also affect sex drive. Weight gain is a common symptom of menopause which can lead to lower self-esteem. This transitional time may also cause some women to feel they are losing their femininity which is a part of their identity.

If you notice a significant shift in your sexual desire, take this opportunity to answer this question you may not have addressed in a while: What drives my desire? Analyzing your answer could help you find additional ways to trigger your desire.

No matter the changes in your sex drive, communication is critical. Your partner needs to know if you’re experiencing discomfort or lower libido. When your partner understands what you’re going through, you can work towards a solution together. 

Experimentation with more comfortable sex positions may be needed. More time allotted for foreplay could help. Using vibrators and clitoris stimulators could also help with arousal before intercourse.

If you do not see improvements, schedule an appointment with a couples counselor or sex coach who may be able to give you further guidance.

Addressing Pain & Dryness

Pain during sex is called dyspareunia. Dyspareunia in postmenopausal women is not uncommon. Occasionally, it could be a sign of a severe condition such as:

  • Vaginitis
  • Sexually transmitted infection
  • Ovarian cysts
  • Scar tissue from surgery
  • Pelvic mass
  • Endometriosis

If you suspect one of these conditions, make an appointment with your doctor.

Vaginal dryness is another menopausal symptom that can affect sex drive. Typically, a thin layer of liquid coats the vagina keeping it moist and the walls more elastic in nature. When estrogen levels drop, blood flow to the vagina decreases, which can cause natural moisture to dry up. This results in itchiness and irritation, especially during sex.

Several remedies can aid with pain during sex and vaginal dryness:

  • Lifestyle changes such as eating a balanced diet, incorporating daily exercises, and minimizing stressors can benefit overall health and be a robust starting place for combating menopause symptoms.
  • Supplements such as black cohosh, red clover, and soy can help alleviate menopause symptoms; however, studies are inconclusive regarding how helpful herbal supplements are. An important reminder — The Food and Drug Administration (FDA) does not regulate herbs and supplements. Consult your gynecologist or healthcare provider to ensure individual supplements don’t interact with your current medications.
  • Lubrication moistens the vagina. Opt for water-based lubrication such as over-the-counter brands like K-Y Jelly or Astroglide. Water soluble lubricants are less likely to be a medium for bacterial growth, and they don’t break down latex in condoms.
  • Pelvic floor exercises, also called Kegel exercises, help to strengthen the pelvic floor. Keeping the pelvic floor fit will assist in preventing urinary incontinence, fecal incontinence, and loss of sexual sensitivity. It also helps keep the bladder and bowel from sagging into the vagina. 
  • Vaginal moisturizers act similarly to lubricants; however, they are not used during intercourse. Vaginal moisturizers are applied a couple of times a week, and they remain in the vagina longer by clinging to the vaginal walls.
  • Bioidentical hormone replacement therapy (bHRT) is an additional option to consider. bHRT can be used to bring low hormones within the body back up to an optimal range so that you can feel better. Testosterone is commonly used to increase libido. It can be used in conjunction with estrogen and progesterone to treat a myriad of symptoms.
  • Vaginal estrogen (vaginal estriol) is a form of low-dose HRT used to address localized symptoms of the vagina and urinary tract. Vaginal estrogen requires a prescription from your healthcare provider.

What are the possible effects of hormone replacement therapy on the sex drive of a woman after menopause? Hormone replacement therapy can help boost libido, although it can take several months for this to occur.

HRT does come with side effects, such as:

  • Acne
  • Increased facial hair
  • Mood swings
  • Weight gain
  • Fatigue
  • Bloating
  • Spotting
  • Cramps
  • Breast tenderness

One other thing: menopause does not make you impervious to Sexually Transmitted Diseases (STDs) and Sexually Transmitted Infections (STIs). Be sure to abide by safe sex practices (use condoms, communicate, have sex with only one person, etc.) to avoid STDs and STIs.

How to Sustain Intimacy

Sex is great, but have you heard of intimacy? Our culture doesn’t talk about this often, but intimacy is not exclusively related to sex. There are many ways to cultivate intimacy in a relationship.

  • Go for a long walk in the park or a scenic drive. Talk through dreams and goals you have. Reminisce on your fondest memories. In-depth conversation in an enjoyable environment is a great way to draw close to your partner.
  • Do something different. Try a new restaurant, volunteer at a local charity, take dancing/cooking lessons, or learn to play a sport together. The act of discovery is far more fun with your favorite person. As you succeed and make mistakes, you’ll share those moments with your partner and be their source of encouragement.
  • Explore each others’ love languages. You can show affection and intimacy in many ways other than sex. Learn which love languages you and your partner prefer, and find creative ways to express these to your partner.
  • Use a different method for intimacy. Take turns giving one another a massage, take a bath/shower together, or make out in the car. These activities can be satisfying on their own.

Ultimately, intimacy is not the result of sex. Intimacy develops out of togetherness, respect, and love. A relationship built on love is sure to last, despite natural changes to one’s sex life.

Menopause Support For Sexual Health & More

One review found that while many women experience some form of sexual dysfunction during menopause, few women disclose it to their healthcare providers. The last thing we want is your struggle to go unaddressed.

Remember, changes in sex after menopause is normal. Any discomfort you’re experiencing is likely treatable. As experts in women’s health, that’s where we come in!

Schedule a discovery call with a care team member to learn about the practice. Sano Health is happy to join you on your journey to a better quality of life


  1. Vivian-Taylor, J., & Hickey, M. (2014). Menopause and depression: is there a link?. Maturitas, 79(2), 142-146. 
  2. Thornton, K., Chervenak, J., & Neal-Perry, G. (2015). Menopause and sexuality. Endocrinology and Metabolism Clinics, 44(3), 649-661.