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Tuesday, February 20, 2024

Frank Talk: Sex in Menopause

By Dr. Robert Wool

Let’s face it: while it seems simple on the surface, sex can be complicated. And for most people, sex changes over time—in terms of frequency, desire, pleasure and more—with ebbs and flows due to many factors beyond what actually happens in the bedroom. There are also changes that occur in women’s bodies and lives as they age, but that doesn’t have to mean an end to intimacy. Sex in menopause is not only still possible, but can actually become better.


Hormonal Changes

You are considered to be in menopause when you have gone 12 consecutive months without a period. But it’s not like flipping a switch. It may take one to several years, a time known as perimenopause, for you to go into menopause. During this time, your hormones are in flux, which means you may have your period some months and not others, and you may notice a range of related symptoms, from hot flashes to changes in mood, sleep and sexual desire.


During menopause, your level of estrogen takes a plunge, which can decrease your desire for sex and also make it harder for you to reach orgasm. Reduced estrogen levels also lead to physical changes, such as reduced vaginal lubrication and elasticity, which can result in pain or discomfort for some women during vaginal sex.


The Bright Side

It can seem like the changes during menopause are working against you, but when it comes to sex, there are many positives as well.


For example, once you’re in menopause, you no longer have to worry about unintended pregnancy, which can be quite freeing for many women. (Just remember that until you are fully in menopause, pregnancy is still possible, even if your period is not regular.)


In addition, no longer having your period means you won’t have the bleeding, cramping and other effects that can make sex more challenging for a few days every month.


In terms of minimizing the impact of menopause on your sex life, there are an increasing number of options:

·         Hormone replacement therapy can help with several menopause-related symptoms, including vaginal lubrication and elasticity.

·         Lubricants can also provide relief from vaginal dryness. Silicone-based lubricants, such as Uberlube, last longer than water-based ones and don’t break down condoms like oil-based products. (Even if you can no longer become pregnant, condoms offer protection against sexually transmitted diseases.)

·         There are several water- or oil-based products available over the counter that can be applied to the genital area to help you experience increased desire and arousal. They help open your blood vessels, increasing blood flow. Be sure to read the packaging as some may not be suitable for use with condoms.

·         Some women find vibrators or clitoral stimulators help to increase their arousal and satisfaction.

·         Getting creative can also help. Try new positions or techniques to see if something works better for you. For example, some women find being on top gives them more control and reduces discomfort.


External Factors

No matter your age, external forces also play a major role in your sex life. Everyday stresses, caretaking responsibilities, illness, injury and more can all take a toll on both you and your partner, making intimacy more challenging. Unless those issues are addressed, your sex life may take a back seat.


There is no right or wrong amount of sex you should be having. Some people find they are fine with less sex and find more pleasure in other forms of intimacy. Others find their desire increases, especially when children grow up and move out, or when work stress is reduced after retirement.


Open Conversations

Talk to your health care provider about any challenges or questions you have about your sex life or changes you experience during menopause. We provide caring, fact-based information without judgment, and can help you find solutions for sex in menopause that are right for your needs.