For many people, the menopause transition comes with a number of sexual changes—including difficulty achieving orgasm and less physically-intense orgasms. And while this change can be challenging, there are plenty of things you can do to keep your sex life hot, fun, and fulfilling. That includes sex toys, lots of lube, and (for some people) hormone therapy. Here’s what you should know about menopause and orgasm.
During menopause, your hormone balance shifts significantly as estrogen and progesterone levels fall. This leads to a number of physical changes that can make penetrative vaginal sex and orgasm more difficult:
First, the walls of your vagina may become thinner, drier, and less flexible. You may also produce less natural lubrication than you used to. This is known as vulvovaginal atrophy, and it can make sex uncomfortable or painful. (Painful sex is very common after menopause, with some studies finding it in up to 29% of women.)
Second, your body’s response to sexual arousal may be less pronounced. Prior to menopause, arousal typically increases the blood flow to your vagina and clitoris. After menopause, however, research shows that this response tends to be weaker. This reduction in blood flow may make you feel less aroused in your genitals, drier, and less sensitive to physical touch.
And third, your pelvic floor muscles may lose strength after menopause. This muscle group (which supports your bladder, bowel, and uterus) is very important for sex. It typically contracts during orgasm—an important part of the orgasm experience for many people. If you’re experiencing weaker pelvic floor contractions after menopause, that could make your orgasms feel less intense. Research shows that weak pelvic floor muscles are linked to sex and orgasm issues after menopause.
“One of the most common questions I get from my patients during menopause is, ‘Where did my orgasm go and how do I get it back?’” says Dr. Leah Millheiser, Clinical Professor of OB/GYN and Chief Medical Officer of Evernow.
“Vaginal estrogen is a very effective treatment for increasing genital blood flow, which is necessary for achieving orgasm. Vibrators are also important, as the slowing down of nerve signals to the clitoris during and after menopause means that stronger stimulation is often needed for orgasm.”
Changes in your sexuality can be emotionally challenging, and may spill over into relationships with other people. The good news is that you have options. If menopause is putting a damper on your sex life, here are a few strategies to try:
A high-quality, silicone-based lube can be a sexual game-changer. You might be surprised by how much it helps if you’re used to producing your own natural lubricant. So use plenty, and reapply as needed during sex. You may also want to try an over-the-counter, non-hormonal vaginal moisturizer. A moisturizer is used as a maintenance therapy 2-3 times a week to help keep your vagina lubricated.
The world of sex toys gets bigger every year. There are countless vibrators, massagers, and other devices that can help you reclaim your sexual pleasure (and maybe discover some new kinds). Whether you use them alone or with a partner, sex toys can be a crucial part of pleasure, arousal, and orgasm. For many people struggling to orgasm during menopause, the right vibrator is a perfect solution. Not sure where to start? Consider the Womanizer or the Satisfyer Pro 2.
Kegel exercises (aka “Kegels”) are a safe, simple way to strengthen your pelvic floor muscles. And as we discussed above, a stronger pelvic floor may mean stronger orgasms. Some small studies have shown that Kegels improve sex for menopausal women. Research also suggests that Kegels may help with urinary leakage/incontinence, which is common during menopause.
If you’re having sex with a partner, the most important thing you can do is communicate clearly and openly. Talk about what feels good and what doesn’t. Share your hopes, fears, and concerns. Make sexual plans together, follow through, and debrief afterwards. When it comes to sex, you really can’t communicate too much.
Hormone therapy (HT) can improve your sex life during menopause by addressing the root of the problem: your declining estrogen level. Local vaginal estrogen is the most effective treatment for genitourinary syndrome of menopause, one symptom of which is painful sex. This treatment uses an insert, ring, pill, or cream to boost your estrogen level directly in the genitourinary tract (vagina, vulva, bladder, urethra). Research has shown that this treatment improves lubrication and orgasm, reduces pain, and improves overall sexual satisfaction after menopause.
Menopause can bring some challenging changes to your sex life. But it can also be an opportunity to experiment with pleasure, learn about your body, and develop new forms of sexual intimacy. If you’re dealing with sex or orgasm issues during menopause, talk with your healthcare team and consider some of our tips above.
“While hot flashes and night sweats are typically time-limited, negative changes in sexual function can last a lifetime,” says Dr. Millheiser. “Not addressing the issue can have a very detrimental effect on quality of life and relationship satisfaction. I encourage any woman with these concerns to speak with a clinician, as there are effective treatments available.”