Let’s Talk About Sex After Menopause

Feb 8, 2022
Medically reviewed by: 
Leah Millheiser, MD

Add it to the list of things they don’t teach in sex ed: Sex changes throughout perimenopause and after menopause. As hormone levels decrease, so too can libido. The way women feel about our bodies may also change with concerns about weight fluctuations, skin changes, hair changes. Meanwhile, we may feel more anxious and fatigued due to hormone shifts.

The combination of emotional and physical changes can make sex unappealing or just low priority—you’re not in the mood. But overcoming the mood hurdle and enjoying sex is possible with some up front effort. Here are five things our Chief Officer, Dr. Leah Millheiser, wants you to know about sex during menopause.

1. Many women will need vibrators to help them achieve orgasm

Changes in biology mean changes in orgasms during and after the menopausal transition. There are a few factors that cause these changes. First, decreased blood flow to the genitalia leads to less engorgement during arousal, which then decreases orgasmic intensity. Changes in pelvic floor muscle tone mean the strength of  muscle contraction during orgasm decreases, too.

Finally,  the signals being conducted through the nerves in the genitalia slow down. This can mean it takes longer to achieve orgasm, or a vibrator is required to get all the way there.

Dr. Millheiser recommends clitoral stimulators, like the Womanizer, which she says are very effective for midlife women who require more intense and focused stimulation.

2. Sexual desire becomes responsive for many women

While many women don’t experience spontaneous desire, they’ll often experience responsive desire. This means your desire and arousal may not show up out of nowhere, but can respond to sexual activity.

Dr. Millheiser recommends “beforeplay.” Think of this as pre-foreplay. “Beforeplay is the idea that a woman creates the responsive desire before she engages with her partner so that she feels as ready to go as her partner does,” Dr Millheiser says.

Beforeplay may involve watching or listening to erotica, masturbation, or anything that reliably gets you in the mood. Dr. Millheiser recommends this especially for women concerned that their partners finish before they’re even getting started. She recommends the Dipsea app, which offers short sexy stories, for women who are looking for some beforeplay inspiration.

3. Some women will need a more serious lubricant

Some of the more common genitourinary symptoms of menopause include vaginal dryness and painful intercourse. Many women rely on water based lubricants, since they are the ones most commonly found on drugstore shelves. However, water-based lubes dry up very quickly. For women who experience a lot of discomfort from friction during sex, water based lubricants aren’t very effective.

Silicone lubricants are a better option. They are as safe as water-based lubricants and they last much longer and more effectively decrease that friction that may cause pain during sex. Most drugstores have at least one silicone based lubricant.

Like anything else, lube can have a learning curve, so keep these things in mind:

  • Like water-based lubricants, silicone-based are safe to use with latex items, like condoms. Silicone based lubricants can also double as a massage oil, and can be used during sexual activity in the water.
  • If you use a silicone covered sex toy, you must use a water-based lubricant. If you are going to stick with a water-based lubricant but find it wearing off too fast, keep a spray bottle with water next to the bed so that you can spray it on your genitals and your partner’s. This reactivates the lubricant that you already have on.
  • Natural oils (e.g., coconut oil, olive oil) can also be used lubricants during sexual activity. However, these oils are not compatible with latex items.

4. The vaginal canal narrows after menopause

As vaginal tissues change due to decreased estrogen, the vaginal canal can narrow, especially around the opening. This narrowed space can lead to discomfort during sex. This tends to occur in women who are not engaging in vaginal penetrative sexual activity very often.

For women experiencing this kind of discomfort, Dr. Millheiser recommends increasing the frequency of vaginal sexual activity, or to use vaginal dilators to help stretch the vaginal canal to a width that allows sex to be more comfortable.

Vaginal dilator therapy is a kind of short-term treatment that women do at home (dilators come in hard plastic or silicone and are easy to purchase online). Dr. Millheiser recommends using the smallest size and working up to the largest. Dilator therapy should be carried out 5 days a week for 20 minutes each time. Once the dilator is placed in the vagina, just let it sit there (it may not go all the way in at first - that’s ok!). You don’t need to move the dilator around once it is in. Placing the largest dilator comfortably may take a few weeks to a few months. Patience is the key to success here. It also helps to place the largest dilator that you can tolerate in the vagina for 5 minutes right before sex to help stretch the vaginal opening.

5. Protection is not an afterthought

STIs are on the rise in older adults, so if you’re dating during menopause, it’s important to practice safer sex and be tested for sexually transmitted infections regularly.